Radiopacity of intracerebral hemorrhage correlates with perihemorrhagic edema

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Experimental evidence indicates that iron plays a key role in edema formation after intracerebral hemorrhage (ICH). We investigated the relationship between ICH radiopacity on CT as a marker of hematoma iron content and perihemorrhagic edema (PHE) after ICH.


We retrospectively investigated patients with spontaneous lobar and ganglionic supratentorial ICH who received follow-up CT scans during the first 7 days after symptom onset (d1, d2–4, d5–7). Measurements of ICH and edema volumes were taken using a semiautomatic threshold-based volumetric algorithm. Radiopacity of the blood clot was determined using the mean Hounsfield unit (HU) count of the ICH.


A total of 117 patients aged 71.92 ± 11.55 years with spontaneous ICH (34.63 ± 32.44 ml) were included in the analysis. Mean ICH radiopacity was 59.7 ± 3.4 HU. We found significantly larger relative PHE at d2–4 (1.7 ± 0.9 vs. 1.3 ± 0.8; P = 0.032) and d5–7 (2.0 ± 1.3 vs. 1.3 ± 0.9; P = 0.007) and larger peak relative PHE (2.3 ± 1.6 vs. 1.6 ± 1.1; P = 0.006) in patients with ICH radiopacity >60 HU (n = 59), as compared to patients with ICH radiopacity <60 HU (n = 58).


Higher ICH radiopacity, reflecting higher in vivo hematoma iron content, is associated with more PHE after ICH.

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