Effect of hematoma puncture and catheter drainage on perihematomal cerebral hemodynamics evaluated by CT perfusion imaging in intracerebral hemorrhage

Abstract

Objective To investigate the effect of hematoma puncture and catheter drainage on perihematomal cerebral hemodynamics in patients with spontaneous supratentorial intracerebral hemorrhage (ICH). Methods A total of 30 patients with spontaneous supratentorial ICH underwent hematoma puncture and catheter drainage. CT perfusion imaging (CTP) was used to determine regions of interest (ROIs) in the central hematoma, perihematomal edema (PHE), peripheral PHE (1 cm from the margin of PHE) and remote cortex in both hematoma side and enantiomorphic contralateral side. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP) of ROIs were measured. Results 1) Different degrees of hypoperfusion existed in perihemtomal brain tissue after ICH: compared with enantiomorphic contralateral side, CBF (P = 0.000) and CBV (P = 0.000) were significantly decreased, MTT was prolonged (P = 0.000), while peak was not reached in the central hematoma; CBF (P = 0.000) and CBV (P = 0.000) were significantly decreased, while MTT was prolonged in PHE (P = 0.000);CBF (P = 0.000) and CBV (P = 0.000) were significantly decreased in peripheral PHE of hematoma side. There was no significant difference on CBF, CBV, MTT and TTP in remote cortex between hematoma side and enantiomorphic contralateral side (P > 0.05, for all). 2) The perfusion parameters showed stepped change from central hematoma to remote cortex: CBF and CBV showed a gradual increase (P < 0.05, for all), and MTT showed a gradual decrease from central hematoma to remote cortex of hematoma side (P < 0.05, for all), while TTP showed no significant difference (P > 0.05). There was no significant difference on CBF, CBV, MTT and TTP among central hematoma, PHE, peripheral PHE and remote cortex of enantiomorphic contralateral side (P > 0.05, for all). 3) CBF (P = 0.000) and CBV (P = 0.000) in PHE after operation were significantly higher than those before operation. Conclusions Hematoma puncture and catheter drainage can effectively improve the perfusion of perihematomal regions.

DOI: 10.3969/j.issn.1672-6731.2018.12.004