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Temporal changes in perihematomal apparent diffusion coefficient values during the transition from acute to subacute phases in patients with spontaneous intracerebral hemorrhage

  • Diagnostic Neuroradiology
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Abstract

Introduction

Diffusion-weighted imaging (DWI) studies focusing on apparent diffusion coefficient (ADC) abnormalities have provided conflicting results about the nature and fate of perihematomal edema.

Methods

We investigated 35 patients with supratentorial spontaneous intracerebral hemorrhage (SICH) by using DWI scanning obtained at 48 h and 7 days after symptom onset. Regional ADC (rADC) values were measured in three manually outlined regions of interest: (1) the perihematomal hyperintense area, (2) 1 cm of normal appearing brain tissue surrounding the perilesional hyperintense rim, and (3) a mirror area, including the clot and the perihematomal region, located in the contralateral hemisphere.

Results

rADC mean levels were lower at 7 days than at 48 h in each ROI (p < 0.00001), showing a progressive normalization of initial vasogenic values. Perihematomal vasogenic rADC values were more frequent (p < 0.00001) at 48 h than at 7 days, whereas perihematomal cytotoxic and normal rADC levels were more represented (p < 0.02 and p < 0.001, respectively) at 7 days than at 48 h. A neurological worsening was more frequent (p < 0.02) in patients with than in those without perihematomal cytotoxic rADC values at 7 days.

Conclusion

Our findings suggest that the transition from acute to subacute phases after SICH is characterized by a progressive resolution of perihematomal vasogenic edema associated with an increase in cytotoxic ADC values. In the subset of patients with perihematomal cytotoxic rADC levels in subacute stage after bleeding, irreversible damage development seems to be related to poor clinical outcome.

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Acknowledgments

The authors thank Dr. Elizabeth Jenkins for helpful corrections to the manuscript.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Corso della Giovecca 203, 44100, Ferrara, Italy

    Enrico Fainardi, Massimo Borrelli, Andrea Saletti, Luca Borgatti & Stefano Ceruti

  2. Neurosurgery Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria, Ferrara, Italy

    Silvio Sarubbo, Francesco Latini & Michele Cavallo

  3. Section of Neurology, Department of Medical and Surgical Sciences of the Communication and Behaviour, University of Ferrara, Ferrara, Italy

    Gloria Roversi

  4. Section of Radiology, Department of Surgical, Anesthesiological and Radiological Sciences, University of Ferrara, Ferrara, Italy

    Andrea Bernardoni

  5. Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy

    Cristiano Azzini & Alessandro De Vito

  6. Neurocritical Care Unit, Ospedale M. Bufalini, Cesena, Italy

    Arturo Chieregato

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  1. Enrico Fainardi
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Correspondence to Enrico Fainardi.

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Fainardi, E., Borrelli, M., Saletti, A. et al. Temporal changes in perihematomal apparent diffusion coefficient values during the transition from acute to subacute phases in patients with spontaneous intracerebral hemorrhage. Neuroradiology 55, 145–156 (2013). https://doi.org/10.1007/s00234-012-1093-x

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  • DOI: https://doi.org/10.1007/s00234-012-1093-x

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