CT perfusion analysis on the association of permeability surface with hematoma and edema volume in acute spontaneous putaminal and thalamic hematoma

Objective To discuss the correlation of permeability surface (PS) with hematoma and edema volume in acute spontaneous putaminal and thalamic hematoma using CT perfusion imaging. Methods A total of 48 acute spontaneous putaminal and thalamic hemorrhage patients were enrolled in this study during October 2015 and December 2016 at the First Affiliated Hospital of Wenzhou Medical University. At the image slice with maximum size of hematoma, PS was measured by drawing various regions of interest (ROI) including"hot spots", perihematomal regions, outward regions, hemisphere regions and contralateral mirror regions. The relative PS (rPS) was calculated as the ratio of ipsilateral to contralateral PS value in each ROI. Hematoma and edema volumes were traced and obtained with commercial software. Results The"hot spots"PS ((2.8±1.5) ml·100 g-1·min-1) and perihematomal PS ((2.1±1.4) ml·100 g-1·min-1) were both significantly higher than the PS of the contralateral mirror regions ((1.1±0.5) ml·100 g-1·min-1) (P 0.05), nor in hemisphere regions PS and contralateral mirror regions PS (P>0.05). There was no significant difference in"hot spots"rPS and perihematomal rPS (P=0.218). The"hot spots"rPS and Perihematomal rPS were both higher than the rPS of the outward and hemisphere regions (P<0.01). There was no significant difference in the outward and hemisphere regions (P<0.01). The median hematoma volume was 12.63 ml and the median edema volume was 12.36 ml. The edema volume had a positive association with the hematoma volume(r=0.799, P<0.001) and perihematomal PS(r=0.465, P=0.001). Perihematomal PS had a positive association with the hematoma volume (r=0.386, P=0.007). Conclusion The damage of blood-brain barrier around acute spontaneous hematoma can be measured via CT perfusion imaging. Perihematomal PS was associated with the hematoma and edema volume. Key words: Cerebral hemorrhage; Perfusion imaging; Capillary permeability; Brain edema