Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage
Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage
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DOI：
10.1159/000065681
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发表时间：
2002-01-01
影响因子：
2.9
通讯作者：
Koroshetz, WJ
中科院分区：
文献类型：
--
作者：
Rosand, J;Eskey, C;Koroshetz, WJ
急性脑出血（ICH）的最佳血压（BP）管理仍存在争议。血压降低可能限制血肿扩大，但也可能加重缺血。在ICH中报告了局部脑血流量（rCBF）减少。然而，其程度和确切模式仍不确定。动态单切片CT灌注（CTP）快速、易于执行，并提供比PET、SPECT和MRI更高的上级空间分辨率。这可能是最适用的方法来评估血压管理对脑出血的rCBF的影响。我们试图评估CTP是否可以识别5例在症状发作24小时内接受CTP治疗的ICH患者的急性ICH rCBF异常。在血肿周围连续扩张的2 mm环中测量rCBF，并与未受累半球的rCBF进行比较。至CTP的平均时间为9 h（范围3-23）。平均ICH体积为25 ml（范围9-64）。与对侧半球rCBF相比，所有患者的血肿周围灌注均减少。紧邻血肿处rCBF减少最明显（2 mm处p < 0.05，4 mm处p = 0.084，6和8 mm处p > 0.2）。血肿周围rCBF随距血肿周边距离的增加而增加。rCBF随距离的增加率与发病时间相关（p = 0.006）。我们得出结论，CTP确定了ICH中rCBF减少的边缘。低灌注梯度似乎延伸超过血肿边缘至少4 mm，并且可能具有时间依赖性。脑血流量减少是否与血肿周围缺血有关还需要进一步研究。版权所有（C）2002 S. Karger AG，巴塞尔。
Optimum blood pressure (BP) management in acute intracerebral hemorrhage (ICH) remains controversial. BP reduction may limit hematoma expansion, but may also exacerbate ischemia. Reduced regional cerebral blood flow (rCBF) has been reported in ICH. Its extent and precise pattern, however, remain uncertain. Dynamic single-section CT perfusion (CTP) is rapid, easily performed and offers superior spatial resolution to PET, SPECT and MRI. It may be the most applicable method for assessing the effects of BP management on rCBF in ICH. We sought to assess whether CTP can identify rCBF abnormalities in acute ICH in 5 patients with ICH who underwent CTP within 24 h of symptom onset. rCBF was measured in serially expanded 2-mm rings around the hematoma and compared with rCBF in the uninvolved hemisphere. Mean time to CTP was 9 h (range 3-23). Mean ICH volume was 25 ml (range 9-64). Perihematoma perfusion was reduced in all patients compared with contralateral hemisphere rCBF. rCBF reduction was most pronounced immediately adjacent to the hematoma (p < 0.05 at 2 mm, p = 0.084 at 4 mm, p > 0.2 at 6 and 8 mm). Perihematoma rCBF increased as a function of the distance from hematoma perimeter. Rate of rCBF increase over distance correlated With time from onset (p = 0.006). We conclude that CTP identifies a rim of reduced rCBF in ICH. A gradient of hypoperfusion appears to extend at least 4 mm beyond the hematoma edge and may be time dependent. Whether reduced CBF is associated with perihematoma ischemia requires additional study. Copyright (C) 2002 S. Karger AG, Basel.