"Computed Tomography Perihematomal Rims": A Perihematomal Low-Density Area Is a Part of an Acute Brain Hemorrhage

• Sato Takahiro

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

• Nishiyama Yasuhiro

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

• Suda Satoshi

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

• Shimoyama Takashi

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

• Takahashi Shiro

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

• Sakamoto Yuki

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

• Aoki Junya

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

• Suzuki Kentaro

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

• Sekine Tetsuro

  Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan

• Kumita Shin-ichiro

  Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan

• Kimura Kazumi

  Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan

Abstract

Objective Computed tomography (CT) can be used for visualizing acute intracerebral hemorrhages (ICHs) as distinct hyperdense areas and cerebral edema as perihematomal low-density areas (LDAs). We observed a perihematomal LDA on CT, which appeared to be part of a hemorrhage on magnetic resonance imaging (MRI) in acute ICH. We named this "CT perihematomal rim" and evaluated its characteristics and clinical significance. Methods We stratified patients with acute ICH according to the presence or absence of a CT perihematomal rim and then compared their radiologic findings. Logistic regression analyses were performed to assess whether the CT findings can predict the presence of a CT perihematomal rim. Patients Patients within 24 hours of ICH onset who were admitted between September 1, 2014, and October 31, 2018, were registered. Results Overall, 139 patients (91 men; mean age, 66 years) were investigated. CT perihematomal rims were observed in 40 patients (29%). ICH volumes on CT were 30% smaller than those on MRI in patients with CT perihematomal rims. On a multivariate analysis, the presence of a CT perihematomal rim was independently associated with the maximum diameter of the perihematomal LDA. According to a receiver operating characteristic analysis, the maximum LDA diameter threshold was 7.5 mm (sensitivity, 85%; specificity, 83%). Conclusion CT perihematomal rims were observed in 29% of the patients with acute ICH. A perihematomal LDA (>7.5 mm) in acute ICH cases should be considered a CT perihematomal rim. Clinicians should be aware that the ICH volume on CT may be underestimated by 30%.

Journal

• Internal Medicine

  Internal Medicine 60 (15), 2395-2403, 2021-08-01

  The Japanese Society of Internal Medicine

Keywords

• intracerebral hemorrhage
• computed tomography
• magnetic resonance imaging
• perihematomal low-density area

Details

• CRID: 1390007437193083776
• NII Article ID: 130008070629
• DOI: 10.2169/internalmedicine.6653-20
• ISSN: 13497235
• ISSN: 09182918
• Web Site: https://www.jstage.jst.go.jp/article/internalmedicine/60/15/60_6653-20/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2022173926
• Text Lang: en
• Data Source:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed