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Published online before print December 4, 2007, 10.1148/radiol.2461061915
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(Radiology 2008;246:543-552.)
© RSNA, 2008

Neuroradiology

MR Imaging of the Brain 1 Year after Aneurysmal Subarachnoid Hemorrhage: Randomized Study Comparing Surgical with Endovascular Treatment1

Paula Bendel, MD, Timo Koivisto, MD, PhD, Mervi Könönen, MSc, Tuomo Hänninen, MSc, PhD, Heleena Hurskainen, MSc, Tapani Saari, MD, Matti Vapalahti, MD, PhD, Juha Hernesniemi, MD, PhD, and Ritva Vanninen, MD, PhD

1 From the Departments of Clinical Radiology (P.B., M.K., T.S., R.V.), Neurosurgery (T.K., H.H., M.V., J.H.), and Neurology (T.H.), Kuopio University Hospital and Kuopio University, Puijonlaaksontie 2, 70210 Kuopio, Finland; and Department of Neurosurgery, University of Helsinki, Helsinki, Finland (J.H.). Received November 9, 2006; revision requested January 15, 2007; revision received March 19; accepted April 24; final version accepted June 11. Address correspondence to P.B. (e-mail: paula.bendel{at}kuh.fi).

Purpose: To prospectively evaluate, with magnetic resonance (MR) imaging, long-term outcome of the brain after endovascular versus neurosurgical treatment for aneurysmal subarachnoid hemorrhage (aSAH).

Materials and Methods: Institutional review board approval and informed consent were obtained. One hundred sixty-eight (77 men, 91 women; mean age ± standard deviation, 51 years ± 13) patients were randomly assigned to surgical versus endovascular treatment of the ruptured aneurysm with 138 (67 endovascular, 71 surgical) MR examinations 1 year after aSAH. The presence, localization, volumes, and cause of lesions were analyzed with {chi}2, Mann-Whitney U, and Student t tests. Furthermore, correlation between MR-detectable brain parenchymal high-signal intensity (SI) lesions on T2- and intermediate-weighted MR images and neuropsychologic outcome was evaluated by using Spearman correlation coefficient.

Results: Only 44 (31.9%) of 138 patients had no lesions associated with aSAH. According to intention to treat, lesions were more frequent after surgical rather than endovascular treatment, predominating in the frontal (surgical: n = 50, [70.4%] vs endovascular: n = 34 [50.7%], P = .018) and temporal (n = 34 [47.9%] vs n = 15 [22.4%], P = .002) lobes. Only endovascular patients had subtentorial lesions (n = 4 [6.0%], P = .037). Ischemic lesions in the parental artery territory were more frequent in surgical (n = 33 [46.5%]) than in endovascular (n = 15 [22.4%], P = .003) patients, with corresponding mean lesion volumes of 20.9 cm3 ± 46.5 versus 17.6 cm3 ± 35.8 (P = .209). Ischemic lesions in remote vascular territories were equal in frequency and size. Retraction injuries were common in the surgical (n = 40, [56.3%]) treatment group. Ischemic lesion volumes correlated with neuropsychologic test scores.

Conclusion: Parenchymal high-SI lesions on T2- and intermediate-weighted MR images are more frequent after early surgical rather than endovascular treatment of the ruptured aneurysm, and lesion volumes correlate with the neuropsychologic test performance.

© RSNA, 2007