http://jaha.ahajournals.org/content/2/3/e000161.full
Abstract
Background
Spontaneous intracerebral hemorrhage (ICH) is associated with
blood–brain barrier (BBB) injury, which is a poorly understood
factor in ICH pathogenesis, potentially
contributing to edema formation and perihematomal tissue injury. We
aimed to assess
and quantify BBB permeability following human
spontaneous ICH using dynamic contrast‐enhanced magnetic resonance
imaging (DCE
MRI). We also investigated whether hematoma
size or location affected the amount of BBB leakage.
Methods and Results
Twenty‐five prospectively enrolled patients from the Diagnostic
Accuracy of MRI in Spontaneous intracerebral Hemorrhage (DASH)
study were examined using DCE MRI at 1 week
after symptom onset. Contrast agent dynamics in the brain tissue and
general tracer
kinetic modeling were used to estimate the
forward leakage rate (Ktrans) in regions of interest (ROI) in
and surrounding the hematoma and in contralateral mirror–image
locations (control ROI).
In all patients BBB permeability was
significantly increased in the brain tissue immediately adjacent to the
hematoma, that
is, the hematoma rim, compared to the
contralateral mirror ROI (P<0.0001). Large hematomas (>30 mL) had higher Ktrans values than small hematomas (P<0.005). Ktrans values of lobar hemorrhages were significantly higher than the Ktrans values of deep hemorrhages (P<0.005), independent of hematoma volume. Higher Ktrans values were associated with larger edema volumes.
Conclusions BBB
leakage in the brain tissue immediately bordering the hematoma can be
measured and quantified by DCE MRI in human ICH.
BBB leakage at 1 week is greater in larger
hematomas as well as in hematomas in lobar locations and is associated
with larger
edema volumes.
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