Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage

Stella Kidwell, J. L. Saver, J. Mattiello, S. Warach, D. S. Liebeskind, S. Starkman, P. M. Vespa, J. P. Villablanca, N. A. Martin, J. Frazee, J. R. Alger

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Abstract

Background: It has been suggested that a zone of perihematomal ischemia analogous to an ischemic penumbra exists in patients with primary intracerebral hemorrhage (ICH). Diffusion-perfusion MRI provides a novel means of assessing injury in perihematomal regions in patients with ICH. Objective: To characterize diffusion-perfusion MRI changes in the perihematomal region in patients with hyperacute intracerebral hemorrhage. Methods: Twelve patients presenting with hyperacute, primary ICH undergoing CT scanning and diffusion-perfusion MRI within 6 hours of symptom onset were reviewed. An automated thresholding technique was used to identify decreased apparent diffusion coefficient (ADC) values in the perihematomal regions. Perfusion maps were examined for regions of relative hypo- or hyperperfusion. Results: Median baseline NIH Stroke Scale score was 17 (range, 6 to 28). Median hematoma volume was 13.3 mL (range, 3.0 to 74.8 mL). MRI detected the hematoma in all patients on echo-planar susceptibility-weighted imaging and in all seven patients imaged with gradient echo sequences. In six patients who underwent perfusion imaging, no focal defects were visualized on perfusion maps in tissues adjacent to the hematoma; however, five of six patients demonstrated diffuse ipsilateral hemispheric hypoperfusion. On diffusion imaging, perihematomal regions of decreased ADC values were identified in three of 12 patients. All three subsequently showed clinical and radiologic deterioration. Conclusions: A rim of perihematomal decreased ADC values was visualized in the hyperacute period in a subset of patients with ICH. The presence of a rim of decreased ADC outside the hematoma correlated with poor clinical outcome. Although perfusion maps did not demonstrate a focal zone of perihematomal decreased blood flow in any patient, most patients had ipsilateral hemispheric hypoperfusion.

Original languageEnglish (US)
Pages (from-to)1611-1617
Number of pages7
JournalNeurology
Volume57
Issue number9
StatePublished - Nov 13 2001
Externally publishedYes

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Cerebral Hemorrhage
Perfusion
Wounds and Injuries
Hematoma
Diffusion Magnetic Resonance Imaging
Perfusion Imaging
Ischemia
Stroke

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Kidwell, S., Saver, J. L., Mattiello, J., Warach, S., Liebeskind, D. S., Starkman, S., ... Alger, J. R. (2001). Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage. Neurology, 57(9), 1611-1617.

Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage. / Kidwell, Stella; Saver, J. L.; Mattiello, J.; Warach, S.; Liebeskind, D. S.; Starkman, S.; Vespa, P. M.; Villablanca, J. P.; Martin, N. A.; Frazee, J.; Alger, J. R.

In: Neurology, Vol. 57, No. 9, 13.11.2001, p. 1611-1617.

Research output: Contribution to journalArticle

Kidwell, S, Saver, JL, Mattiello, J, Warach, S, Liebeskind, DS, Starkman, S, Vespa, PM, Villablanca, JP, Martin, NA, Frazee, J & Alger, JR 2001, 'Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage', Neurology, vol. 57, no. 9, pp. 1611-1617.
Kidwell S, Saver JL, Mattiello J, Warach S, Liebeskind DS, Starkman S et al. Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage. Neurology. 2001 Nov 13;57(9):1611-1617.
Kidwell, Stella ; Saver, J. L. ; Mattiello, J. ; Warach, S. ; Liebeskind, D. S. ; Starkman, S. ; Vespa, P. M. ; Villablanca, J. P. ; Martin, N. A. ; Frazee, J. ; Alger, J. R. / Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage. In: Neurology. 2001 ; Vol. 57, No. 9. pp. 1611-1617.
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abstract = "Background: It has been suggested that a zone of perihematomal ischemia analogous to an ischemic penumbra exists in patients with primary intracerebral hemorrhage (ICH). Diffusion-perfusion MRI provides a novel means of assessing injury in perihematomal regions in patients with ICH. Objective: To characterize diffusion-perfusion MRI changes in the perihematomal region in patients with hyperacute intracerebral hemorrhage. Methods: Twelve patients presenting with hyperacute, primary ICH undergoing CT scanning and diffusion-perfusion MRI within 6 hours of symptom onset were reviewed. An automated thresholding technique was used to identify decreased apparent diffusion coefficient (ADC) values in the perihematomal regions. Perfusion maps were examined for regions of relative hypo- or hyperperfusion. Results: Median baseline NIH Stroke Scale score was 17 (range, 6 to 28). Median hematoma volume was 13.3 mL (range, 3.0 to 74.8 mL). MRI detected the hematoma in all patients on echo-planar susceptibility-weighted imaging and in all seven patients imaged with gradient echo sequences. In six patients who underwent perfusion imaging, no focal defects were visualized on perfusion maps in tissues adjacent to the hematoma; however, five of six patients demonstrated diffuse ipsilateral hemispheric hypoperfusion. On diffusion imaging, perihematomal regions of decreased ADC values were identified in three of 12 patients. All three subsequently showed clinical and radiologic deterioration. Conclusions: A rim of perihematomal decreased ADC values was visualized in the hyperacute period in a subset of patients with ICH. The presence of a rim of decreased ADC outside the hematoma correlated with poor clinical outcome. Although perfusion maps did not demonstrate a focal zone of perihematomal decreased blood flow in any patient, most patients had ipsilateral hemispheric hypoperfusion.",
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AU - Kidwell, Stella

AU - Saver, J. L.

AU - Mattiello, J.

AU - Warach, S.

AU - Liebeskind, D. S.

AU - Starkman, S.

AU - Vespa, P. M.

AU - Villablanca, J. P.

AU - Martin, N. A.

AU - Frazee, J.

AU - Alger, J. R.

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N2 - Background: It has been suggested that a zone of perihematomal ischemia analogous to an ischemic penumbra exists in patients with primary intracerebral hemorrhage (ICH). Diffusion-perfusion MRI provides a novel means of assessing injury in perihematomal regions in patients with ICH. Objective: To characterize diffusion-perfusion MRI changes in the perihematomal region in patients with hyperacute intracerebral hemorrhage. Methods: Twelve patients presenting with hyperacute, primary ICH undergoing CT scanning and diffusion-perfusion MRI within 6 hours of symptom onset were reviewed. An automated thresholding technique was used to identify decreased apparent diffusion coefficient (ADC) values in the perihematomal regions. Perfusion maps were examined for regions of relative hypo- or hyperperfusion. Results: Median baseline NIH Stroke Scale score was 17 (range, 6 to 28). Median hematoma volume was 13.3 mL (range, 3.0 to 74.8 mL). MRI detected the hematoma in all patients on echo-planar susceptibility-weighted imaging and in all seven patients imaged with gradient echo sequences. In six patients who underwent perfusion imaging, no focal defects were visualized on perfusion maps in tissues adjacent to the hematoma; however, five of six patients demonstrated diffuse ipsilateral hemispheric hypoperfusion. On diffusion imaging, perihematomal regions of decreased ADC values were identified in three of 12 patients. All three subsequently showed clinical and radiologic deterioration. Conclusions: A rim of perihematomal decreased ADC values was visualized in the hyperacute period in a subset of patients with ICH. The presence of a rim of decreased ADC outside the hematoma correlated with poor clinical outcome. Although perfusion maps did not demonstrate a focal zone of perihematomal decreased blood flow in any patient, most patients had ipsilateral hemispheric hypoperfusion.

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