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

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 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