scholarly journals Long-Term Results of the Treatment of Persons with Hodgkin's Lymphoma in a Resource-Constrained Setting: Real-World Data from a Single Center

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Luisa Fernanda Sánchez-Valledor ◽  
Thomas M. Habermann ◽  
Iván Murrieta-Álvarez ◽  
Andrés A. León-Peña ◽  
Yahveth Cantero-Fortiz ◽  
...  
Keyword(s):  
Stem Cell ◽  
Lymph Node ◽  
Ct Scan ◽  
Peripheral Blood ◽  
Fdg Pet ◽  
Clinical Stage ◽  
Ct Scans ◽  
Ann Arbor ◽  
Pet Scans

Background: Hodgkin's lymphoma (HL) is the model of curative care with radiation therapy, combination chemotherapy, staging approaches, peripheral blood stem cell transplantation, and immunotherapy. However, the value of the novel anti cancer drugs has been recently analyzed and questioned in view of the results in the real improvement of overall survival (OS). Material and methods: All consecutive patients seeking medical care after 1986 in our institution as a result of HL and followed for at least 3 months were entered in the study. A diagnosis of HL was based on the histological study of a pathology specimen, mainly a lymph node; the same pathologist analyzed all the specimens and defined the histological subtype. Clinical stage was defined according to the Ann Arbor classification. Bone marrow biopsies were done only in patients with clinical stages III or IV. Computed tomography (CT) scans were done in all cases, prior to starting the treatment. Fluorodeoxyglucose positron emission tomography (FDG-PET) scans were performed since 2002. Between 1986 and 1997, patients were treated with MOPP, and after 1997 with ABVD as frontline therapy. For stages I and II, four cycles of chemotherapy were delivered and a computerized tomography (CT) scan was performed; if lymph node enlargement were present at this point in time, four additional cycles were given, whereas two additional cycles were given if the CT scan was negative. For stages III and IV, the CT scans were performed at the end of six cycles and two or four more cycles. Mediastinal radiotherapy was delivered only to persons with a positive FDG-PET scan at the end of the treatment. Patients showing activity after these treatments were considered as refractory and treated with four courses of ICE (ifosfamide, carboplatin and etoposide). Autologous or allogeneic peripheral blood hematopoietic stem cell transplants (HSCT) were given to refractory patients after achieving a complete remission (CR): High-dose melphalan (200mg/m2) was employed in autologous transplants, whereas cyclophosphamide, fludarabine and busulfan were employed in allogeneic transplants, all of them from HLA-identical siblings. After the completion of the treatment, patients were every two months for one year and every four months later on. No FDG-PET scans were done during the follow up, unless clinically indicated. Results: Among 91 patients with HL identified between 1986 and 2020, 88 were followed three months or more and were included in the analysis. There were 37 females and 51 males. The median age was 29years (range5-73years). There were 62 patients with nodular sclerosing HL (70%), 19 mixed cellularity (HL), 2 lymphocyte depleted HL, and one lymphocyte predominant HL; in 4 cases the histologic variant could not be defined. According to Ann Arbor classification, 5 patients were found in stage I, 48 in stage II, 19 in stage III and 16 in stage IV. Ten patients presented with a mediastinal mass larger than 10 cm. in the chest X-ray film. Three cases presented with relapsed disease. Patients have been followed for a median of 114 months (range4-402). 44 patients are alive, 10 have died and 34 were lost to follow-up. Median OS for all the patients has not been reached, being above 402 months, the OS at 310 months is 88% and at 402 months 77%. Median OS has not been reached and is above 94, 109, 90 and 98 months for stages I, II, III and IV, respectively (p=0.2). The 310-month OS was 83% for patients treated with MOPP and 88% for those treated with ABVD (HR:0.76, 95% CI 0.2-2.8; p=0.6).Sixteen patients (18%) were refractory to the treatment and 9 (10%) relapsed; they were treated with ICE followed by HSCT (autologous 15 patients and allogeneic 10 patients). Patients who underwent auto-HSCT had a median survival of 329.1 months and an OS of 92.3%, whereas those given allo-HSCT had a median survival of 59.3 months and an OS of 45.7% (HR0.2, 95%CI 0.04-1.3, p=0.057). The OS of patients given or not HSCT was 73.5% and 92.9% at 266 and 404 months, respectively (HR4.09, 95%CI 1.0-16.6, p=0.01). The OS was similar. The causes of death were breast carcinoma in 2 cases, liver carcinoma in one and uncontrolled lymphoma activity in the remaining. Conclusion: HL may be less aggressive in Mexican population than in Caucasians. Combined chemotherapy renders acceptable results, irrespective of clinical stage. Disclosures No relevant conflicts of interest to declare.

Preliminary Results of FDG-PET Scanning after GDP Chemotherapy Prior to Autologous Stem Cell Transplant (ASCT) for Relapsed/Refractory (RR) Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4645-4645
Author(s):  
Matthew D. Cooper ◽  
Umberto Falcone ◽  
Naom Tau ◽  
Eshetu G Atenafu ◽  
Richard Tsang ◽  
...  
Keyword(s):  
Stem Cell ◽  
Fdg Pet ◽  
Pet Scan ◽  
Ct Scans ◽  
Pet Ct ◽  
Significant Difference ◽  
Additional Chemotherapy ◽  
Pet Scans ◽  
Additional Therapy

Abstract Introduction: Gemcitabine, dexamethasone and cisplatin (GDP) has become a standard salvage chemotherapy (SC) regimen for relapsed/refractory (RR) lymphoma prior to autologous stem cell transplantation (ASCT) (Crump JCO 2014). Response to SC is now evaluated using 18-Fluoro-deoxyglucose positron-emission-tomography (FDG-PET) scans based on the recent Lugano classification (Cheson JCO 2014). We evaluated the response of patients (pts) with Hodgkin lymphoma (HL) and aggressive non-Hodgkin lymphoma (NHL) to GDP by PET-CT scans and attempted to determine whether PET was predictive of outcome. Methods: We performed a retrospective chart review of consecutive HL and DLBCL (diffuse large B-cell lymphoma) pts who underwent ASCT following GDP SC at our centre between January 2014 and July 2016. All pts previously received anthracycline-based chemotherapy (typically ABVD for HL or R-CHOP for NHL) for primary treatment. Pts underwent FDG-PET scans after 3 cycles of SC and scans were retrospectively reported with the Deauville Criteria Scale with Deauville scores of 1-3 considered negative, whereas scores of 4 or 5 represented a positive result. Response to GDP was documented with CT scans using 1999 Working group Criteria (JCO 1999). Pts proceeded to ASCT if they had a PR by CT imaging and no signs of PD on PET-CT. Post-PET radiation or additional chemotherapy could be given at the discretion of the treating physician. Progression free survival (PFS) and overall survival (OS) were calculated by the Kaplan-Meier method from the date of progression or date of ASCT. Statistical analysis to determine the significance of PET result on outcome was performed using the long rank test. Results: 45 pts with DLBCL and 29 pts with HL were identified: median age was 45 (range: 23-69) and 29 (range: 19-58) years respectively. Baseline patient characteristics are listed in Table 1. Following GDP SC, PET Deauville scores of 1-3 were reported in 55% of HL and 29% of DLBCL pts. Overall response rate to GDP by CT was 72% for HL pts and 64% for DLBCL pts (Table 2). For HL, 100% (16/16) of pts with a PET(-) scan and 91% (10/11) with a PET(+) result proceeded to ASCT. 85% (11/13) of DLBCL pts who had a PET(-) scan and 48% (15/31) with a PET(+) scan underwent ASCT. Additional therapy post PET scan included involved field radiation, additional chemotherapy (mini-BEAM) or novel therapy (brentuximab and bendamustine for HL patients). Median follow-up time was 14.2 months (HL) and 13.4 months (DLBCL) from relapse/progression after initial chemotherapy; and 9.6 months (HL) and 10.9 months (DLBCL) from ASCT. There was a statistically significant difference between PET(+) and PET(-) DLBCL patients from the time of initial disease progression for PFS (26% versus 69%, p=0.011) that did not reach statistical significance for OS (p=0.072). However, there was no significant difference for PFS and OS in DLCBL from ASCT when stratified by PET result (p= 0.154 and p=0.723 respectively). In HL pts, no statistically significant differences for PFS and OS from progression (p=0.480 and p=0.387 respectively) or from ASCT (p=0.579 and p=0.450 respectively) were found when stratified by PET result (see Tables 3 and 4). Conclusion: Deauville 4-5 PET scores appear to be predictive of PFS for RR-DLBCL pts. The lack of a significant difference between PET results for OS in DLBCL is likely due to sample size and the need for longer follow-up. For RR-HL pts, PFS and OS rates were both high but did not seem to noticeably differ by PET result. Additional therapy employed for Deauville 4-5 patients peri-ASCT could influence outcome. Overall, PET response assessment post GDP appears to stratify outcome in patients with DLBCL and PET adapted therapy in HL patients may improve outcome in Deauville 4-5 patients. Review of pending cases and subsequent follow-up is ongoing. Disclosures No relevant conflicts of interest to declare.

Early Pre/Post Fluoro-Deoxyglucose Positive Emission Tomography (PET) Does Not Predict Outcome of Patients Undergoing Hematopoietic Stem Cell Transplantation in Hodgkins Disease and Non-Hodgkins Lymphoma.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2180-2180
Author(s):  
Jeanne Palmer ◽  
Timothy Goggins ◽  
Gloria Broadwater ◽  
Nelson J. Chao ◽  
John Chute ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Fdg Pet ◽  
Pet Scan ◽  
Cell Transplant ◽  
Hodgkins Lymphoma ◽  
Radiology Reports ◽  
Fdg Pet Scan ◽  
Pet Scans

Abstract This study was designed to investigate the predictive value of early pre/post stem cell transplant (SCT) FDG-PET on outcomes in non hodgkins (NHL) or Hodgkins lymphoma (HL). We analyzed patients who received SCT for treatment of relapsed or refractory NHL or HL at Duke Medical Center between the years of 1996–2007. Patients who had either a FDG-PET scan following salvage chemo- or radio- therapy and within 14 weeks of transplantation (pre-PET)or a FDG PET scan within 6–14 weeks following transplantation (post-PET) were included in the analysis. PET was determined to be positive or negative based on chart review of radiology reports. Survival times are estimated using Kaplan- Meier method. Hazard ratios (HR) are from univariate Cox proportional hazards models. Overall survival (OS) was measured from the time of transplant until death, and for those patients still alive, it was censored at the last follow up date. Disease free survival (DFS) was measured from the time of transplant until first progression or death, whichever occurred first, and was censored at the date of last follow up for those alive without progression. A total of 102 patients were identified with PET in the appropriate time period. Median age was 48.5 (18–78); 71 patients had NHL, 31 patients had HL. Ninety-eight (96%) of the patients had chemosensitive disease, and had a documented PR (62) or CR (36) prior to transplant. The median DFS and OS of this population was 55 and 73 mo respectively. Median time to follow up was 38 mo (1.5 – 145 mo). Of the 75 pre-PET scans, 32 (43%) were positive; of the 78 post-PET scans, 22 (28%) were positive. At the time of this analysis, 28 (27%) of the patients had died from disease progression. There were 8 (10.6%) pre-PET, and 7 (9%) post- PET readings that were not clear. Our analysis revealed that neither pre-PET nor post-PET results were predictive of DFS (HR 1.73 p=0.16, HR 1.97 p = 0.052) or OS (HR 1.92 p=0.13; HR1.65 p=0.21). Further, for the patients who had measurable disease at the entry to SCT, post-PET was not predictive for DFS (HR 1.62, p=0.29) or OS (HR 1.59 p=0.35). Exclusion of unclear PET readings did not have any effect on these results. In subset analysis, post- PET did predict DFS in patients with NHL (HR 2.6 p=0.034). Our results suggest that early pre/post SCT PET analysis is not beneficial in this algorithm for predicting overall survival in these patients. Negative post-PET may predict DFS in patients with aggressive NHL, however, did not predict OS in this group. Our analysis indicates that other methods of determining risk of relapse and transplant outcome are needed.

Active Surveillance Strategies Have Neither Clinical or Survival Benefit Following High-Dose Chemotherapy and Progenitor Cell Rescue in Follicular Lymphoma.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3251-3251
Author(s):  
Marco Gerlinger ◽  
Janet Matthews ◽  
Andy Davies ◽  
T. Andrew Lister ◽  
Silvia Montoto ◽  
...  
Keyword(s):  
Stem Cell ◽  
Follicular Lymphoma ◽  
Ct Scan ◽  
Median Time ◽  
Ct Scans ◽  
High Dose ◽  
Clinical Relapse ◽  
Stem Cell Rescue ◽  
Time To Relapse

Abstract Introduction: Annual surveillance CT scans and bone marrow (BM) biopsies are frequently performed in follow-up of patients (pts.) receiving high-dose therapy (HDT) with autologous stem cell rescue for recurrent follicular lymphoma (FL). The impact of this active surveillance strategy on the outcome of a homogeneously treated population was analysed. Methods: Ninety-nine consecutive pts. who received HDT (cyclophosphamide and total body irradiation) with autologous stem cell rescue for recurrent FL at St Bartholomew’s Hospital between February 1986 and October 1991 were included. The surveillance policy at that time included an annual CT scan and BM biopsy. Time to relapse, time to next treatment and overall survival (OS) from the time of HDT were calculated and compared, according to whether disease progression had been diagnosed on the basis of surveillance investigations or on clinical grounds. Seventy out of 99 pts. are evaluable, the remainder are not, due to: relapse or death within one year of HDT (20 pts.), follow-up elsewhere (8 pts.) or patient’s wishes (1 pt.). 86% of pts. who commenced surveillance actually had annual CT scans and BM biopsies until disease progression or death. Results: After a median follow-up of 16.7 years (y), progression was documented in 35/70 pts. (50%). It was detected by surveillance alone in 14 pts. and clinically, in 21 pts. (40% and 60% of all recurrences, respectively). The commonest presentations of clinical relapse were peripheral lymphadenopathy (62%), pain (19%) and B-symptoms (10%). Surveillance relapses were diagnosed on the basis of a CT scan in 43% of pts., a BM biopsy in 36% and both in 14%. The median time from HDT to relapse was 2y for pts. with a clinically detected relapse and 2.8y in those with a surveillance relapse but the difference was not statistically significant (p=0.2). Treatment was started immediately in 13 of 21 pts. (62%) with a clinical relapse, contrasting with only one of 14 pts. (7%) diagnosed on surveillance. The main reasons for starting treatment were biopsy-proven transformation to diffuse large B-cell pathology (8 of the pts. with a clinical relapse and one with a surveillance relapse) and rapidly progressing lymphadenopathy. All other pts. were managed expectantly (observation). The median time from HDT until clinical progression was 8.2y in the 14 pts. whose relapse was detected by surveillance; 4 of the 14 have not yet developed signs or symptoms of recurrence. Thus, the clinical relapse rate in the cohort under surveillance is 44% (31/70). Six of the pts. with a surveillance relapse have still not started treatment (median follow-up: 13.8y; range: 1.9y–22.1y). Only 2 of the 21 pts. with a clinically detected relapse have not started treatment after 5.6y and 14.3y of follow-up. Thus, the median time from HDT to next treatment was significantly shorter for pts. with a clinical relapse (3.6y) in comparison with those in whom the recurrence was diagnosed by surveillance investigations (11.3y; p=0.0004). Median OS was 5.6y and 13.4y for pts. with a clinical and a surveillance relapse, respectively (p=0.03). Conclusions: In pts. with FL, relapses diagnosed on the basis of surveillance investigations usually have an indolent course and frequently do not require treatment. In contrast, clinically detected relapses have a more aggressive clinical course and treatment is initiated immediately in the majority of cases. Thus, annual surveillance investigations do not help to identify pts. that require treatment and do not improve the outcome of this population. They should therefore be abandoned. Time to relapse based on data from pts. on annual surveillance should be interpreted with caution because of the poor correlation with time to next treatment and OS.

FDG-Positron Emission Tomography in T-Cell Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1614-1614
Author(s):  
Chiara Rusconi ◽  
Cristina Gabutti ◽  
Vittorio Ruggero Zilioli ◽  
Erika Meli ◽  
Maddalena Mazzucchelli ◽  
...  
Keyword(s):  
T Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
Clinical Stage ◽  
T Cell Lymphoma ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Scans

Abstract Abstract 1614 Background: Few data are available on the role of fluoro-deoxy-glucose positron emission tomography (FDG-PET) in T-cell non Hodgkin Lymphoma (NHL). We compared standard contrast-enhanced computerized tomography (CECT) and FDG-PET for initial staging and restaging after treatment in T-cell NHL. Methods: We reviewed 58 FDG-PET scans performed in 29 patients (pts) affected by T-cell NHL and we focused on the 42 cases for which a simultaneous standard CECT was available for comparison. The specific T-cell histology was Peripheral T-Cell Lymphoma Not Otherwise Specified in 12 pts, Angioimmunoblastic T-Cell Lymphoma in 4 pts, Anaplastic Large Cell Lymphoma in 10 pts, other T-NHL hystologies in 3 pts. Twelve pts were males and median age at diagnosis was 57 years (range: 25–77). Baseline FDG-PET scans were 20, while FDG-PET performed for disease reassessment were 22. Results: FDG-PET performed at baseline was positive in all cases. In 6 cases (30%) FDG-PET identified fewer disease sites than CECT, while in 14 cases (70%) FDG-PET identified additional disease sites. New sites identified by FDG-PET were: other nodal sites (11 pts), spleen (2 pts), nasopharynx (1 pt) and testicles (1 pt). Different disease extent evaluation according to FDG-PET modified clinical stage in 10 pts (50%): one pt was downstaged and 9 pts were upstaged. FDG-PET-based stage was not considered for therapeutic decision. FDG-PET scans performed at restaging were negative in 16 cases (72%) and positive in the remaining 6 cases (28%). In 13/16 (81%) negative cases CECT was concordant and showed a complete remission, while in the remaining 3 cases CECT showed a residual nodal disease. In the 6 FDG-PET positive cases, CECT was as follows: abnormal in the same site of FDG-PET in 1 case, abnormal in fewer sites than FDG-PET in 3 cases and abnormal in more sites than FDG-PET in 2 cases. With a median follow-up of 32 months, the median overall survival (OS) of the 6 positive FDG-PET cases at restaging was 26 months. With a median follow-up of 23 months, the median OS of the 16 negative FDG-PET cases at restaging was not reached. Conclusion: FDG-PET can be useful in the initial staging of T-cell NHL, since it can allow a more accurate disease extension evaluation: in our experience it could identify additional sites, both nodal and extra-nodal, in 70% of pts. A change in clinical stage according to FDG-PET was observed in 50% of cases, with an upstaging in the majority of pts. We could confirm the high sensitivity of baseline FDG-PET in T-cell NHL. A high level of concordance was observed between PET and CECT at restaging. However, independently on CECT result, the worse OS of FDG-PET positive cases confirms the role of FDG-PET as prognostic factor for survival. Larger prospective trials are needed to confirm the utility of FDG-PET in baseline staging, reassessment after chemotherapy and treatment planning. Disclosures: No relevant conflicts of interest to declare.

Usefulness of F-18 FDG PET/CT in the Follow-up of POEMS Syndrome After Autologous Peripheral Blood Stem Cell Transplantation

2012 ◽  
Vol 37 (2) ◽  
pp. 181-183 ◽  
Author(s):  
Antonella Stefanelli ◽  
Giorgio Treglia ◽  
Lucia Leccisotti ◽  
Luca Laurenti ◽  
Marco Luigetti ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Fdg Pet ◽  
Peripheral Blood Stem Cell ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Blood Stem Cell Transplantation

Detection of Relapse in Diffuse Large B-Cell Lymphoma (DLBCL) and Hodgkin’s Lymphoma (HL): Observations and Implications for Post-Remission Radiologic Surveillance.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2428-2428
Author(s):  
Marin F. Xavier ◽  
Stephen J. Schuster ◽  
Charalambos Andreadis ◽  
Lisa Downs ◽  
Bernadette Diccion ◽  
...  
Keyword(s):  
Fdg Pet ◽  
B Cell Lymphoma ◽  
Ct Scanning ◽  
Ct Scans ◽  
High Dose ◽  
Primary Therapy ◽  
X Rays ◽  
Surveillance Imaging ◽  
Pet Scans

Abstract According to reports in the literature since 1991, 5–30% of relapses of DLBCL and HL were identified by surveillance X-rays and CT scans in the post-remission setting. Recently, a large series of DLBCL relapses were analyzed and suggested that surveillance imaging can identify early relapse in a population of patients with a more favorable outcome (Leidtke et al, Ann Oncol 17: 909–913, 2006). We retrospectively evaluated 40 patients with relapses of HL and DLBCL after complete remission from three referral lymphoma practices between 2000–2006 at the University of Pennsylvania. Relapsed disease was identified after primary therapy or after salvage chemotherapy and high-dose therapy with autologous stem cell transplantation. These relapsed patients underwent post-remission surveillance CT scans with or without PET scans roughly every 3–4 months for the first 1–2 years and every 6–12 months thereafter for at least 5 years. Seventeen patients had DLBCL and 23 had HL. Among relapses, 22 (55%) were detected with surveillance imaging and 18 (45%) were detected by clinical findings (10 complaints of lymphadenopathy, 2 with B-symptoms, 2 with both B-symptoms and lymphadenopathy, 3 with pain, 1 with cough, 1 with physician-detected lymphadenopathy, and none by laboratory results alone). Among the asymptomatic relapses detected by surveillance imaging, PET scanning detected 4 cases of DLBCL (36%) and 3 cases of HL (27%) relapses not identified by other techniques. In summary, compared to prior reports, our series reveals a much higher proportion of relapses detected by surveillance imaging in both diseases. We have adhered to a protocol similar to the NCCN 2006 guidelines; including CT scans as a part of follow-up evaluation. This schedule is more intensive than surveillance reported in prior studies, perhaps accounting for our higher rate of radiographic relapse detection. FDG-PET scans performed in combination with follow-up CT scans detected additional early relapses not seen by CT scanning alone. Prospective screening studies looking at the role of FDG-PET scans combined with CT scans to detect earlier relapses is warranted. Whether early detection of relapse provides a survival advantage should be evaluated in larger prospective studies in both HL and DLBCL.

Abstract TP291: Hematoma Retraction and Perihematoma Hypodensity in Neutral Brain Model of Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Shahram Majidi ◽  
Basit Rahim ◽  
Sarwat I Gilani ◽  
Waqas I Gilani ◽  
Malik M Adil ◽  
...  
Keyword(s):  
Biological Activity ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Early Period ◽  
Ct Scans ◽  
Hematoma Expansion ◽  
Human Cadaver ◽  
Fresh Blood ◽  
The Right

Background: The temporal evolution of intracerebral hematomas and perihematoma edema in the ultra-early period on computed tomographic (CT) scans in patients with intracerebral hemorrhage (ICH) is not well understood. We aimed to investigate hematoma and perihematoma changes in “neutral brain” models of ICH. Methods: One human and 6 goat cadaveric heads were used as “neutral brains” to provide physical properties of the brain without any biological activity or new bleeding. ICH was induced by slow injection of 4 ml of fresh blood into the right basal ganglia of the goat brains. Similarly, 20 ml of fresh blood was injected deep into the white matter of the human cadaver head in each hemisphere. Serial CT scans of the heads were performed at 0, 1, 3, and 5 hours after inducing ICH. Analyze software (AnalyzeDirect, Overland Park, KS) was used to measure hematoma and perihematoma hypodensity volumes in the baseline and follow up CT scans. Results: The initial hematoma volumes of 11.6 ml and 10.5 ml in the right and the left hemispheres of the human cadaver brain gradually decreased to 6.6 ml and 5.4 ml at 5 hours, showing 43% and 48% retraction of hematoma, respectively. The volume of the perihematoma hypodensity in the right and left hemisphere increased from 2.6 ml and 2.2 ml in the 1 hour follow up CT scans to 4.9 ml and 4.4 ml in the 5 hour CT scan, respectively. Hematoma retraction was also observed in all six ICH models in the goat brains. The mean ICH volume in the goat heads was decreased from 1.49 ml in the baseline CT scan to 1.01 ml in the 5 hour follow up CT scan showing 29.6% hematoma retraction. Perihematoma hypodensity was visualized in 70% of ICH in goat brains, with an increasing mean hypodensity volume of 0.4 ml in the baseline CT scan to 0.8 ml in the 5 hour follow up CT scan. Conclusion: Our study demonstrated that substantial hematoma retraction and perihematoma hypodensity occurs in intracerebral hematomas in the absence of any new bleeding or biological activity of the surrounding brain. Such observations suggest that active bleeding is underestimated in patients with no or small hematoma expansion and our understanding of perihematoma hypodesity needs to be reconsidered.

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