Contrast leakage distant from the hematoma in patients with spontaneous ICH: A 7 T MRI study

Abstract

Disruption of the blood-brain barrier (BBB) might play a role in the pathophysiology of cerebral small vessel disease-related ICH. The aim of this study was to assess presence and extent of contrast agent leakage distant from the hematoma as a marker of BBB disruption in patients with spontaneous ICH. We prospectively performed 7 tesla MRI in adult patients with spontaneous ICH and assessed contrast leakage distant from the hematoma on 3D FLAIR images. Thirty-one patients were included (mean age 60 years, 29% women). Median time between ICH and MRI was 20 days (IQR 9-67 days). Seventeen patients (54%; seven lobar, nine deep, one infratentorial ICH) had contrast leakage, located cortical in 16 and cortical and deep in one patient. Patients with contrast leakage more often had lobar cerebral microbleeds (CMBs; 77%) than those without (36%; RR 2.5, 95% CI 1.1-5.7) and a higher number of lobar CMBs (patients with contrast leakage: median 2, IQR 1-8 versus those without: median 0, IQR 0-2; p = 0.02). This study shows that contrast leakage distant from the hematoma is common in days to weeks after spontaneous ICH. It is located predominantly cortical and related to lobar CMBs and therefore possibly to cerebral amyloid angiopathy.

Keywords: Blood–brain barrier; cerebral microbleeds; intracerebral hemorrhage; magnetic resonance imaging; small vessel disease.

Figure 1.

Examples of patients with different HARM scale scores. HARM 1: Punctate lesion of contrast leakage. Pre- (panel A) and postgadolinium (panel B) FLAIR images of a 41-year-old man with an infratentorial hemorrhage, a right frontal punctate lesions (white arrow) of contrast leakage and no abnormalities at that site on SWI (panel C). HARM 2: Multiple punctate lesions of contrast leakage. Pre- (panels D and E) and postgadolinium (panels G and H) FLAIR images of a 54-year-old man with left deep ICH, right occipital (white arrow) and left frontal lesions (white open arrow) of contrast leakage and no abnormalities at those sites on SWI (panel F and I). HARM 3: Focal sulcal contrast leakage. Pre- (panel J) and postgadolinium (panel K) FLAIR images of a 45-year-old man with a left deep ICH, left parietal focal sulcal contrast leakage (white arrow) and no abnormalities at that site on SWI (panel L). HARM 4: Bilateral and diffuse contrast leakage. Pre- (panel M) and postgadolinium (panel N) FLAIR images of a 67-year-old woman with right deep ICH, extensive bilateral and generalized occipital contrast enhancement (white arrows) and multiple cerebral microbleeds at that site on SWI (panel O).

Figure 1.

Examples of patients with different HARM scale scores. HARM 1: Punctate lesion of contrast leakage. Pre- (panel A) and postgadolinium (panel B) FLAIR images of a 41-year-old man with an infratentorial hemorrhage, a right frontal punctate lesions (white arrow) of contrast leakage and no abnormalities at that site on SWI (panel C). HARM 2: Multiple punctate lesions of contrast leakage. Pre- (panels D and E) and postgadolinium (panels G and H) FLAIR images of a 54-year-old man with left deep ICH, right occipital (white arrow) and left frontal lesions (white open arrow) of contrast leakage and no abnormalities at those sites on SWI (panel F and I). HARM 3: Focal sulcal contrast leakage. Pre- (panel J) and postgadolinium (panel K) FLAIR images of a 45-year-old man with a left deep ICH, left parietal focal sulcal contrast leakage (white arrow) and no abnormalities at that site on SWI (panel L). HARM 4: Bilateral and diffuse contrast leakage. Pre- (panel M) and postgadolinium (panel N) FLAIR images of a 67-year-old woman with right deep ICH, extensive bilateral and generalized occipital contrast enhancement (white arrows) and multiple cerebral microbleeds at that site on SWI (panel O).

Figure 1.

Examples of patients with different HARM scale scores. HARM 1: Punctate lesion of contrast leakage. Pre- (panel A) and postgadolinium (panel B) FLAIR images of a 41-year-old man with an infratentorial hemorrhage, a right frontal punctate lesions (white arrow) of contrast leakage and no abnormalities at that site on SWI (panel C). HARM 2: Multiple punctate lesions of contrast leakage. Pre- (panels D and E) and postgadolinium (panels G and H) FLAIR images of a 54-year-old man with left deep ICH, right occipital (white arrow) and left frontal lesions (white open arrow) of contrast leakage and no abnormalities at those sites on SWI (panel F and I). HARM 3: Focal sulcal contrast leakage. Pre- (panel J) and postgadolinium (panel K) FLAIR images of a 45-year-old man with a left deep ICH, left parietal focal sulcal contrast leakage (white arrow) and no abnormalities at that site on SWI (panel L). HARM 4: Bilateral and diffuse contrast leakage. Pre- (panel M) and postgadolinium (panel N) FLAIR images of a 67-year-old woman with right deep ICH, extensive bilateral and generalized occipital contrast enhancement (white arrows) and multiple cerebral microbleeds at that site on SWI (panel O).

Figure 1.

Examples of patients with different HARM scale scores. HARM 1: Punctate lesion of contrast leakage. Pre- (panel A) and postgadolinium (panel B) FLAIR images of a 41-year-old man with an infratentorial hemorrhage, a right frontal punctate lesions (white arrow) of contrast leakage and no abnormalities at that site on SWI (panel C). HARM 2: Multiple punctate lesions of contrast leakage. Pre- (panels D and E) and postgadolinium (panels G and H) FLAIR images of a 54-year-old man with left deep ICH, right occipital (white arrow) and left frontal lesions (white open arrow) of contrast leakage and no abnormalities at those sites on SWI (panel F and I). HARM 3: Focal sulcal contrast leakage. Pre- (panel J) and postgadolinium (panel K) FLAIR images of a 45-year-old man with a left deep ICH, left parietal focal sulcal contrast leakage (white arrow) and no abnormalities at that site on SWI (panel L). HARM 4: Bilateral and diffuse contrast leakage. Pre- (panel M) and postgadolinium (panel N) FLAIR images of a 67-year-old woman with right deep ICH, extensive bilateral and generalized occipital contrast enhancement (white arrows) and multiple cerebral microbleeds at that site on SWI (panel O).