Abstract Details

Title Quantification of Hematoma Hounsfield Units on Noncontrast CT Does Not Predict Clearance of Acute Intraventricular Hemorrhage after Intraventricular Recombinant Tissue Plasminogen Activator

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 240

Objective

Background BACKGROUND: Thin-section noncontrast CT (NCCT) provides a measure of thrombus composition based on HU and may predict resistance to thombolytics in acute ischemic stroke. Hematoma composition may affect thrombolytic efficacy of TPA in acute intraventricular hemorrhage (IVH).

Design/Methods DESIGN/METHODS: Serial NCCT was performed on 52 patients who received intraventricular TPA as part of the CLEAR IVH trial (Clot Lysis: Evaluating Accelerated Resolution of IVH) and 12 controls with IVH treated with external ventricular drainage alone. A blinded investigator calculated HU values for IVH volumes on admission, day 3-4 and day 6-9 NCCT for each patient.

Results RESULTS: Median IVH volume on admission for TPA-treated patients was 38.3(iqr 34.1)cc, and decreased to 4.9(14.5)cc at day6-9. Mean(SD) HU for IVH was 52.1(4.3) on presentation and decreased significantly to 50.1(4.5) on day3-4, and to 45.1(4.95) on day6-9. IVH HU count was significantly correlated with IVH volume at all CT timepoints: admission:p=0.002; day3-4:p<0.001; day6-9:p<0.001. There was no correlation between admission serum platelet count, fibrinogen level or hemoglobin and clot HUs. Only CSF protein was positively correlated with IVH HU (p=0.03). Total IVH HUs were significantly lower in TPA-treated patients at day6-9 (p=0.001), but not at day3-4. Change in IVH volume from admission to day3-4 was positively correlated with higher initial HU in TPA-treated patients (p=0.04), but HU was not significant after adjustment for IVH volume and TPA treatment.

Conclusions CONCLUSIONS: Hounsfield Unit counts of IVH decrease significantly over the first week on NCCT and the decrease is greater in TPA-treated patients. Unlike thrombus HUs in large intracranial vessels, IVH HUs are not associated with erythrocyte or platelet concentrations. Higher HU is not an independent predictor of success of intraventricular thrombolysis.

Authors/Disclosures
Joshua A. Kornbluth, MD (Tufts Medical Center) PRESENTER	Dr. Kornbluth has received personal compensation for serving as an employee of Tufts Medical Center. Dr. Kornbluth has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for ERI. Dr. Kornbluth has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for CRICO. The institution of Dr. Kornbluth has received research support from Vivonics, Inc.
	No disclosure on file
Natalie Ullman, MD (Children's Hospital of Philadelphia)	No disclosure on file
Daniel F. Hanley, MD, FAAN (Johns Hopkins Medicine, Acute Care Neurology)	Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurotrope. Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. The institution of Dr. Hanley has received research support from NIH/NCATS. The institution of Dr. Hanley has received research support from NIH/NINDS.
Wendy C. Ziai, MD (Johns Hopkins Univ, Neuro Critical Care)	Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Ziai has received research support from NIH. Dr. Ziai has received publishing royalties from a publication relating to health care. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant with DOJ.
L J. Greenfield, Jr., MD, PhD, FAAN (UConn Health Center)	Dr. Greenfield has received publishing royalties from a publication relating to health care.

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