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(Stroke. 2007;38:319.)
© 2007 American Heart Association, Inc.

Original Contributions

Quantitative Perihematomal Blood Flow in Spontaneous Intracerebral Hemorrhage Predicts In-Hospital Functional Outcome

Ashis H. Tayal, MD; Rishi Gupta, MD; Howard Yonas, MD; Tudor Jovin, MD; Ken Uchino, MD; Maxim Hammer, MD; Lawrence Wechsler, MD James M. Gebel, MD

From the Department of Neurology and University of Pittsburgh Medical Center Stroke Institute (A.H.T., R.G., T.J., K.U., M.H., L.W., J.M.G.); the Veterans Administration Pittsburgh Health Care System and University of Pittsburgh Medical Center Stroke Institute (T.J.), and the Department of Neurosurgery and University of Pittsburgh Medical Center Stroke Institute (H.Y.), University of Pittsburgh, Pittsburgh, Pa.

Correspondence to James M. Gebel Jr, MD, 6400 Dutchmans Ln, Suite 145, Louisville KY 40205. E-mail j.gebel{at}att.net

Background and Purpose— Few data on xenon computed tomography-based quantitative cerebral blood flow (CBF) in spontaneous intracerebral hemorrhage have been reported. We correlated perihematomal CBF in a retrospective series of 42 subacute spontaneous intracerebral hemorrhage patients undergoing xenon computed tomography with in-hospital discharge status and mortality.

Methods— We calculated 3 area-weighted mean CBF values: (1) within the computed tomography-visible rim of perihematomal edema, (2) within a 1-cm marginal radius around the hematoma, and (3) all cortical regions of interest immediately adjacent to the hematoma. Primary outcomes were in-hospital mortality and discharge status (ordinally as 0=home, 1=acute rehabilitation, 2=nursing home, 3=death). Discharge status was used as a surrogate for in-hospital functional outcome.

Results— Median hematoma volume was 14.4 cm³ (range, 2 to 70). Median perihematomal (low-attenuation rim) CBF was 21.9 cm³·100 g^–1·min^–1 (range, 6.1 to 81.1), and the median 1-cm marginal radius CBF was 26.8 cm³·100 g^–1·min^–1 (range, 10.8 to 72.8). The median regional cortical CBF was 26.7 cm³·100 g^–1·min^–1 (range, 6.9 to 72.6). Eight patients had 1-cm marginal radius or regional cortical CBF values <20 cm³·100 g^–1·min^–1. Hematoma volume (odds ratio [OR], 1.68 per 10-cm³ volume; P=0.036) and intraventricular hemorrhage (OR, 1.88 per grade of intraventricular hemorrhage; P=0.036) predicted mortality. Two CBF measures, hydrocephalus, and IVH predicted poor in-hospital functional outcome in bivariate analysis. Each CBF measure (OR, 0.34 to 0.43; P<0.001 to 0.003) and intraventricular hemorrhage (OR, 3.42; P<0.001) predicted in-hospital functional outcome in multivariable analyses.

Conclusions— Most spontaneous intracerebral hemorrhage patients lack perihematomal penumbra. Perihematomal CBF independently predicts in-hospital discharge status but not in-hospital mortality. Further studies are warranted to determine whether perihematomal CBF predicts long-term functional outcomes.

Key Words: cerebral blood flow • intracerebral hemorrhage • outcomes

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