Ghani, Zulkifli Zaki Abdul
(2006)
Preliminary study of CT perfusion of penumbra in patients with hypertensive intracranial haemorrhage.
Masters thesis, Universiti Sains Malaysia.
Abstract
TOPICS
Preliminary study of CT perfusion of penumbra in patient with hypertensive intracranial
haemorrhage
INTRODUCTION
Hypertension is a major illness in Malaysia with a prevalence of 24% (Zaher et al., 1998)
and haemorrhagic stroke is its complications which much more likely to result in death or
major disability than cerebral infarction(Broderick et al., 1993).
Nonenhanced Computed Tomography (NECT) scan is the most common imaging modality
used to diagnose intracranial haemorrhage (ICH). There were controversial issues whether
medical or surgical treatment benefits these patients. CT perfusion (CTP) allowed the study
of cerebral perfusion. TheoreticalJy it is useful in selecting for treatment option.
Modified Barthel index (MBI) was a reliable disability scale (Suiter et al., 1999) and used
as outcome assessment.
OBJECTIVE
This preliminary study was aimed to determine perfusion characteristics of perihaematoma
region and correlation with clinical outcome. These will be used as predictor of the outcome
whether medical or surgical treatment benefits the patients. This study also aimed to find
contributing factors of abnormal perfusion in perihaematoma of hypertensive ICH and
factors affecting its clinical outcome.
MATERIAL AND METHOD
From July 2004 till November 2005, I 0 patients were enrolled as they fulfilled the inclusion
criteria and written informed consent obtained.
NECT scan was done to confirm ICH then CTP was performed. The data were analyzed at
the CT workstation. Haematoma volume and distance from skull were measured in NECT
scan. Perihaematoma regions were divided into four sections in relation to distance from the
skull. The regions of interest were drawn based on CTP colour mapping. Each parameters
of perfusion were produced by the perfusion software and were analyzed whether selected
region were normal, penumbra or umbra perfusion status. MBI was scored at presentation
and 4 weeks.
RESULT
Significant statistical Spearman correlation at the 0.05 level (2-tailed) noted between ages
and initial MBI, and haematoma volumes with haematoma distances to skull. Significant
Pearson correlation of haematoma volume and ischaemic injury sizes at the 0.01 level (2-
tailed) noted.
Perfusion ischaemic injury were found in perihaematoma region however no statistical
correlation of the perihaematoma area with clinical outcome.
CONCLUSION
CTP is a useful, easy and practical method in assessing intracranial perihaematoma
perfusion however no correlation with clinical outcome. A bigger sample size may reverse
these findings.
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