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Published online before print December 19, 2006, 10.1148/radiol.2422051698

(Radiology 2006;242:518.)

A more recent version of this article appeared on December 1, 2006
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© RSNA, 2006

Neuroradiology

Subarachnoid Hemorrhage in the Subacute Stage: Elevated Apparent Diffusion Coefficient in Normal-appearing Brain Tissue after Treatment1

Yawu Liu, MD, PhD, Ville Soppi, MD, Timo Mustonen, MD, Mervi Könönen, MD, Timo Koivisto, MD, PhD, Anna Koskela, MD, Jaakko Rinne, MD, PhD and Ritva L. Vanninen, MD, PhD

1 From the Departments of Clinical Radiology (Y.L., T.M., M.K., A.K., R.L.V.), Neurosurgery (V.S., T.K., J.R.), and Clinical Neurophysiology (M.K.), Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland. Received October 17, 2005; revision requested December 8; revision received January 17, 2006; accepted February 17; final version accepted May 5. Supported by Kuopio University Hospital (EVO funding 5063515) and the Instrumentarium Science Foundation. Address correspondence to Y.L. (e-mail: yawu.liu{at}kuh.fi).

Purpose: To prospectively evaluate whether subarachnoid hemorrhage (SAH) is associated with a change in the apparent diffusion coefficient (ADC) in normal-appearing brain parenchyma.

Materials and Methods: Institutional review board approval and informed consent were obtained for all patient and volunteer studies. One hundred patients (48 men, 52 women; mean age, 52 years ± 12 [standard deviation]) with aneurysmal SAH underwent conventional and diffusion-weighted magnetic resonance (MR) imaging at a mean of 9 days ± 3 after SAH to evaluate possible lesions caused by SAH, treatment of SAH, and vasospasm. Aneurysms were treated surgically (n = 70) or endovascularly (n = 30) before MR imaging. Diffusion-weighted MR imaging was performed at 1-year follow-up in 30 patients (10 men, 20 women; mean age, 51 years ± 11). Thirty healthy age-matched volunteers (11 men, 19 women; mean age, 54 years ± 16) underwent MR imaging with an identical protocol. ADC values were measured bilaterally in the gray and white matter (parietal, frontal, temporal, occipital lobes; cerebellum; caudate nucleus; lentiform nucleus; thalamus; and pons) that appeared normal on T2-weighted and diffusion-weighted MR images. Linear mixed model was used for comparison of ADC values of supratentorial gray matter and white matter; general linear regression analysis was used for comparison of ADC values of cerebellum and pons.

Results: In patients with SAH, the ADC values in normal-appearing white matter, with a single exception in the frontal lobe (P = .091), were significantly higher than they were in healthy volunteers (P ≤ .011). The differences disappeared by 1 year, except in parietal white matter (P = .045). The ADC values of cortical gray matter did not significantly differ between patients and volunteers (P ≥ .121).

Conclusion: SAH and its treatment may cause global mild vasogenic edema in white matter and deep gray matter that is undetectable on T2-weighted and diffusion-weighted MR images but is detectable by measuring the ADC value in the subacute stage of SAH.

© RSNA, 2006