What question did this study set out to answer?

To investigate the relationship between hematoma coagulation and perihematomal edema volume in acute intracerebral hemorrhage patients.

July 24, 2026Neurocritical Care0 citationsOpen Access

Hematoma Coagulation is Associated with Perihematoma Edema Volume in Patients with Acute Intracerebral Hemorrhage

GCG. A. Castro SBSeth Boren FHFaruk Md. Hossain

Key Points

To investigate the relationship between hematoma coagulation and perihematomal edema volume in acute intracerebral hemorrhage patients.
Twenty patients with hypertensive intracerebral hemorrhage underwent three MRI scans within 72 hours post-onset.
Hematoma and perihematoma volumes measured using 3D FLAIR, T1-weighted, and multi-gradient echo sequences.
Correlational analysis between clotted blood volume and edema volume performed using Wilcoxon signed-rank tests.
PHE volume increased significantly from T1 to T3 (22.6 ± 14.2 to 31.5 ± 20.2 mL; p = 0.005).
Clotted blood volume increased significantly from T1 to T3 (3.21 ± 3.3 to 5.58 ± 4.8 mL; p = 0.0007).
Significant positive correlation found between clotted blood volume and PHE volume at T2 (r = 0.543, p < 0.05) and T3 (r = 0.80, p < 0.001).

Abstract

Abstract Background In acute intracerebral hemorrhage (ICH), hematoma mass and perihematomal edema (PHE) contribute to elevated intracranial pressure (ICP). The release of red blood cell lysis products accelerates PHE formation. Animal studies show that the accumulation of blood-clotting factors contributes to PHE growth. Controlling hematoma expansion (HE) remains a medical priority. Promoting hematoma coagulation reduces HE; however, coagulation may increase PHE. Using quantitative magnetic resonance imaging (MRI) for imaging coagulation status, we studied the interaction between coagulation and PHE. Methods Twenty patients with hypertensive ICH who completed three consecutive MRIs at three time points (T1, T2, T3) within the first 72 h after onset were included in this study. Images were obtained on a 3 T MRI system with three-dimensional (3D) FLAIR, T1w, and multi-gradient echo (mGRE) sequences. FLAIR and mGRE images quantified the hematoma volume (HV) and PHE volume, while clotted blood volume (CBVol) was measured via Quantitative Susceptibility Maps (QSM). Within the hematoma, voxels with susceptibility greater than 0.5 ppm were considered clotted blood. CBVol was analyzed in relation to hematoma and PHE volumes. Group-wise comparisons across serial time points were performed using Wilcoxon signed-rank tests. Results Among 12 M/8F patients, the mean age was 63.4 ± 11.5 years. Between the first (T1) and last imaging (T3), the PHE volume (22.6 ± 14.2 to 31.5 ± 20.2 mL; p = 0.005), and CBVol (3.21 ± 3.3 to 5.58 ± 4.8 mL; p = 0.0007) significantly increased. The CBVol demonstrated a significant positive correlation with PHE volume at T2 ( r = 0.543, p < 0.05) and T3 ( r = 0.80, p < 0.001). After adjusting for HV, the association remained independently significant at T3 (partial r = 0.554, p = 0.021). Similarly, HV showed a strongly significant association with PHE volume at all time points ( p < 0.001), and after adjusting for CBVol, the association remained significant across all time points (partial r = 0.578–0.692, all p < 0.02). Conclusions Both hematoma clotting and hematoma size influence PHE volume. The findings of this study have implications for clinical management when treating patients with procoagulant therapies.

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