Study Of ASL And ~1H-mrs In Perihematoma Edema In Acute Intracerebral Hemorrhage

Objectives: Analysis the regional cerebral blood flow(CBF) and cerebral metabolism in perihematoma edema in Acute Intracerebral Hemorrhage by arterial spin labeling(ASL) and proton magnetic resonance spectroscopy(1H-MRS) scan,to study the correlation among regional CBF and regional metabolism and neurological deficits.Research Design and Methods: The study was performed in the inpatients(n=18,14 male and 4 female) with acute supratentorial spontaneous intracerebral hemorrhage of the Neurology Department of the Second Hospital of Dalian Medical University from December 2013 to February 2015, and age ranging from 33 to 76 years old(57.33±13.05),hematoma volume ranging from 1.26 ml to 15.96ml(7.07±5.06)(calculated according to Dotian formula).1H-MRS and ASL scan were performed in all patients at 2 to 7 days after hemorrhage onset, the routine magnetic resonance imaging(MRI) including T1 weighted imaging(T1WI),T2 weighted imaging(T2WI),diffusion weighted imaging(DWI) and fluid attenuated inversion recovery(FLAIR)sequence were performed at the same time.The regional cerebral blood flow(CBF) and N-acetylaspartate/ creatine(NAA/Cr) ratio both in perihematoma edema area(1-cm region surrounding the hematoma) and contralateral corresponding region were measured. National Institutes of Health Stroke Scale(NIHSS) was assessed by the same trained licensed neurologist at the day MRI performed. The data were analyzed by SPSS 13.0 software.Results: The data of 17 patients were finally analyzed except one patient because of the unsatisfactory 1H-MRS spectra and CBF map.The CBF in perihematoma edema area(32.67±7.61 ml/100 g per minute) was significantly less than the contralateralcorresponding region(55.08±16.43 ml/100 g per minute)(p<0.01).The NAA/Cr ratio in perihematoma edema area(0.61±0.44) was significantly less than the contralateral corresponding region(1.73±1.23)(p<0.01). There were no correlation between r CBF(the ratio of CBF between perihematoma edema area and the contralateral corresponding region) and r NAA/Cr(the ratio of NAA/Cr between perihematoma edema area and the contralateral corresponding region)(r=-0.022, p=0.933). Regional CBF was not correlated with NAA/Cr(r=-0.027, p=0.918) in perihematoma edema area. NIHSS score was not correlated with r CBF(r=-0.096, p=0.715) and r NAA/Cr(r=-0.014, p=0.958) and NAA/Cr(r=0.117, p=0.655) and CBF(r=0.390, p=0.122) in perihematoma edema area. Ipsilateral cerebral hemisphere hypoperfusion was observed in 6 cases in ASL-CBF map.Surrounding the core of the hematoma were high signal on DWI map and slightly high signal in ADC(apparent diffusion coefficient) map in all of the 17 cases. Lactate peak was detected in perihematoma edema in 5 cases.Conclusions: 1.There were regional CBF decreased and neuronal damage in perihematoma edema area in Acute Intracerebral Hemorrhage; 2.There were no correlation among regional CBF decreased and neuronal damage and neurological deficits in perihematoma edema area in Acute Intracerebral Hemorrhage.