title: Magnetic resonance imaging profile of blood-brain barrier injury in patients with acute intracerebral hemorrhage.
abstract: 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.
  
  
  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.
authors.affiliation: Stanford Neurocritical Care Program, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA. daksoy@stanford.edu
authors.forename: Didem
authors.initials: D
authors.lastname: Aksoy
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.forename: Chitra
authors.initials: C
authors.lastname: Venkatasubramanian
authors.forename: Irina
authors.initials: I
authors.lastname: Eyngorn
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Snider
authors.forename: Sandeep N
authors.initials: SN
authors.lastname: Gupta
authors.forename: Rashmi
authors.initials: R
authors.lastname: Narayana
authors.forename: Nancy
authors.initials: N
authors.lastname: Fischbein
authors.forename: Christine A C
authors.initials: CA
authors.lastname: Wijman
mesh_terms: D000208:Acute Disease; D001812:Blood-Brain Barrier / Q000293:injuries* / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology*; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: blood–brain barrier; dynamic contrast‐enhanced MRI; intracerebral hemorrhage; magnetic resonance imaging; stroke