Application of CT perfusion imaging in acute spontaneous hypertension intracerebral hemorrhage patients

Objective To quantify hemodynamic changes in patients with acute spontaneous hypertensive intracerebral hemorrhage(shICH) using computed tomography perfusion(CTP) imaging.Methods 26 patients(22 men and 4 women,age range 33～74,mean age 55.08 years) who suffered from a supratentorial shICH,were at admission and received CTP scanning within 8～19 h(mean 14.88 h) after symptom onset.At the maximum levels of the hematoma,cerebral blood flow(CBF),cerebral blood volume(CBV) and mean transit time(MTT) were measured in three different regions of interest(ROI)manually outlined on CT scan: ① hemorrhagic core(hyperdense on unenhanced CT image);② perihematomal area(isodense within 1 cm rim of perilesion area);③ normal area far from ipsilateral hemorrhage,and ④ a mirrored area(CBVn,CBFn,MTTn),including the clot and the perihematomal region located in the contralateral hemisphere.rCBF,rCBV,rMTT were calculated(rCBV=CBV/CBVn,rCBF=CBF/CBFn,rMTT=MTT/MTTn).ResultsThe CBF,CBV,and MTT color maps showed a centrifugal distribution with a gradual improvement from the core of hematoma to the periphery.The CBV,CBF,and MTT value of perihematoma area were(16.48±17.38) ml·100g-1·min-1),(1.61±1.53) ml·100g-1),(9.12±2.57) s,respectively.There was significantly decreased CBF,CBV and prolonged MTT in perihematomal group against contralateral mirrored area(ZCBV=-2.603,ZCBF=-4.178,tMTT =4.747,P0.05).Variance analysis showed the difference of the perfusion parameters,including MTT,rCBF,rCBV,rMTT,among intrahematoma,perihematoma group and the remote areas was significant(FMTT=9.04,FrCBF=25.02,FrCBV=38.03,FrMTT=12.49,P0.05).The values of MTT,rMTT,rCBF between perihematomal group and remote area had statistically difference by LSD analysis(P0.05),but there was no statistically difference of rCBV between the two groups(P0.05).Mean CBF value of perihematomal group was lower than that of remote area(Z=-2.288,P0.05),but the difference of mean CBV in the two groups was not statistical significant(Z=-0.357,P0.05).Conclusion Multi-parametric CTP imaging can indicate low perfusion states around hematoma in acute shICH patients,but there is no evidence of ischemic penumbra.