Open AccessMagnetic Resonance Imaging Profile of Blood–Brain Barrier Injury in Patients With Acute Intracerebral Hemorrhage
Author(s) -
Aksoy Didem,
Bammer Roland,
Mlynash Michael,
Venkatasubramanian Chitra,
Eyngorn Irina,
Snider Ryan W.,
Gupta Sandeep N.,
Narayana Rashmi,
Fischbein Nancy,
Wijman Christine A. C.
Publication year - 2013
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.113.000161
Subject(s) - medicine , hematoma , intracerebral hemorrhage , magnetic resonance imaging , radiology , edema , blood–brain barrier , nuclear medicine , anesthesia , central nervous system , glasgow coma scale
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 (K trans ) 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 K trans values than small hematomas ( P <0.005). K trans values of lobar hemorrhages were significantly higher than the K trans values of deep hemorrhages ( P <0.005), independent of hematoma volume. Higher K trans 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.