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Voxel-based analysis of apparent diffusion coefficient in perihaematomal oedema: associated factors and outcome predictive value for intracerebral haemorrhage
  1. Yuan-Hsiung Tsai1,2,
  2. Li-Ming Hsu2,
  3. Hsu-Huei Weng1,
  4. Ming-Hsueh Lee3,
  5. Jen-Tsung Yang3,
  6. Ching-Po Lin2,4
  1. 1Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
  2. 2Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan, Republic of China
  3. 3Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
  4. 4Institute of Neuroscience, National Yang Ming University, Taiwan, Republic of China
  1. Correspondence to Dr Ching-Po Lin; chingpolin{at}gmail.com

Abstract

Objectives The pathophysiology of perihaematomal oedema (PO) surrounding a primary intracerebral haemorrhage (ICH) is complicated and incompletely understood. We prospectively investigated the components of PO with voxel-based analysis of the apparent diffusion coefficient (ADC) value and assessed its predictive value for functional outcome.

Design Forty-six patients with ICH who were enrolled for clinical evaluation underwent MRI scans within 24 h after ICH. Based on the ADC value of the ipsilateral voxels divided by the mean ADC value of the contralateral mirror region of interest, the voxels with oedema were classified into three categories: cytotoxic, vasogenic and undetermined. The percentages of cytotoxic and vasogenic oedema were then calculated and correlated with clinical outcome according to the modified Rankin Scale (mRS) at 6 months after ICH. The intraobserver and interobserver reliability of this method were examined using intraclass correlation coefficients.

Results The intraclass correlation coefficients showed that analysis using the voxel-based method is highly reliable. Among the clinical variables tested, age and serum creatinine levels were positively correlated with percentage of cytotoxic oedema. Age, history of coronary artery disease, National Institutes of Health Stroke Scale score and percentage of cytotoxic oedema were all associated with mRS at 6 months after ICH.

Conclusions The pathophysiological processes within PO are complicated. Voxel-based analysis of ADC values may help to identify the components of PO and may be beneficial for decision making and predicting outcome.

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Footnotes

  • To cite: Tsai Y-H, Hsu L-M, Weng H-H, et al. Voxel-based analysis of apparent diffusion coefficient in perihaematomal oedema: associated factors and outcome predictive value for intracerebral haemorrhage. BMJ Open 2011;1:e000230. doi:10.1136/bmjopen-2011-000230

  • Funding This research was partly supported by the Chang Gung Medical Research Fund, Chang Gung Memorial Hospital, Taiwan (CMRPG690461 and CMRPG690471).

  • Competing interests None.

  • Ethics approval The Institutional Review Board of Chang Gung Memorial Hospital approved this study.

  • Contributors The authors' responsibilities were as follows: T-YH: study design, MRI data collection and analysis, and manuscript production; H-LM, W-HH: analysis and interpretation of data; L-CP: study design and editing of the manuscript; L-MH, Y-JT: clinical data collection and discussion. All authors were responsible for critical revisions and final approval of the manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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