title: Early Quantification of Hematoma Hounsfield Units on Noncontrast CT in Acute Intraventricular Hemorrhage Predicts Ventricular Clearance after Intraventricular Thrombolysis.
abstract: OBJECTIVE
  Thrombolytic efficacy of intraventricular rtPA for acute intraventricular hemorrhage may depend on hematoma composition. We assessed whether hematoma Hounsfield unit quantification informs intraventricular hemorrhage clearance after intraventricular rtPA.
  
  
  METHODS
  Serial NCCT was performed on 52 patients who received intraventricular rtPA as part of the Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage trial and 12 controls with intraventricular hemorrhage, but no rtPA treatment. A blinded investigator calculated Hounsfield unit values for intraventricular hemorrhage volumes on admission (t0), days 3-4 (t1), and days 6-9 (t2). Controls were matched uniquely to 12 rtPA-treated patients for comparison.
  
  
  RESULTS
  Median intraventricular hemorrhage volume on admission for patients treated with intraventricular rtPA was 31.9 mL (interquartile range, 34.1 mL), and it decreased to 4.9 mL (interquartile range, 14.5 mL) (t2). Mean (±standard error of the mean) Hounsfield unit for intraventricular hemorrhage was 52.1 (0.59) at t0 and decreased significantly to 50.1 (0.63) (t1), and to 45.1 (0.71) (t2). Total intraventricular hemorrhage Hounsfield unit count was significantly correlated with intraventricular hemorrhage volume at all time points (t0: P = .002; t1: P < .001; t2: P < .001). On serologic and CSF analysis at t0, only higher CSF protein was positively correlated with intraventricular hemorrhage Hounsfield units (P = .03). In 24 matched patients treated with rtPA and controls, total intraventricular hemorrhage Hounsfield units were significantly lower in patients treated with rtPA at t2 (P = .02). Higher Hounsfield unit quantification of fourth ventricle hematomas independently predicted slower clearance of this ventricle (95% CI, 0.02-0.14; P = .02), along with higher intraventricular hemorrhage volume (95% CI, 0.02-0.41; P = .03) and lower CSF protein levels (95% CI, -0.003 to -0.002; P < .001).
  
  
  CONCLUSIONS
  Intraventricular hemorrhage Hounsfield unit counts decrease significantly in the acute phase and to a greater extent with intraventricular rtPA treatment. Intraventricular hemorrhage Hounsfield units are correlated significantly with CSF protein and not with serum erythrocyte or platelet concentrations. Hounsfield unit counts may reflect intraventricular hemorrhage clot composition and rtPA sensitivity.
authors.affiliation: From the Department of Neurology (J.K.), Division of Neurocritical Care, Tufts University School of Medicine, Boston, Massachusetts Department of Neurology (J.K., J.R.C., W.Z.), Division of Neurocritical Care.
authors.forename: J
authors.initials: J
authors.lastname: Kornbluth
authors.affiliation: Department of Neurology (S.N.-T., N.U., J.R.C., D.F.H., W.Z.), Division of Brain Injuries Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: S
authors.initials: S
authors.lastname: Nekoovaght-Tak
authors.affiliation: Department of Neurology (S.N.-T., N.U., J.R.C., D.F.H., W.Z.), Division of Brain Injuries Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: N
authors.initials: N
authors.lastname: Ullman
authors.affiliation: Department of Neurology (J.K., J.R.C., W.Z.), Division of Neurocritical Care Department of Neurology (S.N.-T., N.U., J.R.C., D.F.H., W.Z.), Division of Brain Injuries Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: J R
authors.initials: JR
authors.lastname: Carhuapoma
authors.affiliation: Department of Neurology (S.N.-T., N.U., J.R.C., D.F.H., W.Z.), Division of Brain Injuries Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: D F
authors.initials: DF
authors.lastname: Hanley
authors.affiliation: Department of Neurology (J.K., J.R.C., W.Z.), Division of Neurocritical Care Department of Neurology (S.N.-T., N.U., J.R.C., D.F.H., W.Z.), Division of Brain Injuries Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland. wziai1@jhmi.edu.
authors.forename: W
authors.initials: W
authors.lastname: Ziai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator