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Leak Sign on Dynamic-Susceptibility- Contrast Magnetic Resonance Imaging in Acute Intracerebral Hemorrhage

Investigative Magnetic Resonance Imaging 2020년 24권 3호 p.154 ~ 161
박지강, 홍대영, 진선탁, 이동우, 편해욱,
소속 상세정보
박지강 ( Park Ji-Kang ) - Pohang Stroke and Spine Hospital Department of Radiology
홍대영 ( Hong Dae-Young ) - Pohang Stroke and Spine Hospital Department of Neurosurgery
진선탁 ( Jin Sun-Tak ) - Pohang Stroke and Spine Hospital Department of Neurosurgery
이동우 ( Lee Dong-Woo ) - Pohang Stroke and Spine Hospital Department of Neurosurgery
편해욱 ( Pyun Hae-Wook ) - Pohang Stroke and Spine Hospital Department of Radiology

Abstract


Purpose: A CT angiography spot sign (CTA-spot) is a significant predictor of the early expansion of an intracerebral hemorrhage (ICH-Ex). Dynamic-susceptibility-contrast magnetic resonance imaging (DSC-MRI) can track the real-time leaking of contrast agents. It may be able to indicate active bleeding, like a CTA-spot.

Materials and Methods: From September 2014 to February 2017, we did noncontrast CT, CTA, and DSC-MRI examinations of seven patients with acute ICH. We investigated the time from symptom onset to the first contrast-enhanced imaging.
We evaluated the time course of the contrast leak within the ICH at the source image of the DSC-MRI and the volume change of ICH between non-contrast CT and DSCMRI. We compared the number of slices showing CTA-spots and DSC-MRI leaks.

Results: The CTA-spot and DSC-MRI leak-sign were present in four patients, and two patients among those showed ICH-Ex. The time from the symptom onset to CTA or DSC-MRI was shorter for those with a DSC-MRI leak or CTA-spot than for three patients without either (70-130 minutes vs. 135-270 minutes). The leak-sign began earlier, lasted longer, and spread to more slices in the patients with ICH-Ex than in those without ICH-Ex. The number of slices of the DSC-MRI leak and the number of the CTA-spot were well correlated.

Conclusion: DSC-MRI can demonstrate the leakage of GBCA within hyperacute ICH, showing the good contrast between hematoma and contrast. The DSC-MRI leakage sign could be related to the hematoma expansion in patients with ICH.

키워드

Intracerebral hemorrhage; CTA-spot sign; DSC-MRI

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