Abstract TP333: The Volume of an Acute Intracerebral Hemorrhage May Be Larger Than it Appears on Computed Tomography Scan

Abstract

Background and Purpose: Computed tomography (CT) scan is difficult to detect early-onset acute intracerebral hemorrhage (ICH) rich in fresh blood correctly. We identified the presence of a perihematomal low-density lesion on CT imaging, which showed a high-intensity signal on T2-weighted imaging and an iso-intensity signal on fluid-attenuated inversion recovery imaging in magnetic resonance imaging (MRI) (Figure. A~C). It located inside of the hypo-intensity rim at the edge of hematoma on gradient recalled echo T2*-weighted imaging (Figure. D). We named it the “CT wall sign” and investigated the association with imaging findings in acute ICH. Methods: Patients with acute ICH within 24 hours from onset who underwent non-contrast head CT and MRI scan at the same time periods were included. The ICH volumes on CT and MRI (cm 3 ) were measured using a three-dimensional slicer and compared. Subjects were divided according to the presence or absence of the CT wall sign and compared the neuroradiological variables. Statistical analyses were performed to evaluate the association between the CT wall sign and other imaging findings. Results: A total of 146 patients were included and the CT wall sign was observed in 42 (29%) patients. The difference in the ICH volume between MRI and CT were significantly larger in the CT wall sign-positive group than in -negative group (6.0 cm 3 versus 0.40 cm 3 , P <0.001). The presence of CT wall sign was significantly associated with putamen hemorrhage ( P =0.049), large hematoma > 11.36 cm 3 ( P =0.005), and niveau formation in the hematoma ( P <0.001). Conclusions: The presence of the CT wall sign suggests that the volume of an acute ICH may be larger than it appears on CT imaging. Key words: Acute intracerebral hemorrhage, Computed tomography, Magnetic resonance imaging, Perihematomal low-density area.