This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Carhuapoma, J. R. Articles by Barker, P. B. Search for Related Content PubMed PubMed Citation Articles by Carhuapoma, J. R. Articles by Barker, P. B. Related Collections Acute Cerebral Hemorrhage Computerized tomography and Magnetic Resonance Imaging Intracerebral Hemorrhage

(Stroke. 2000;31:726.)
© 2000 American Heart Association, Inc.

Original Contributions

Diffusion-Weighted MRI and Proton MR Spectroscopic Imaging in the Study of Secondary Neuronal Injury After Intracerebral Hemorrhage

Juan R. Carhuapoma, MD; Paul Y. Wang, MD; Norman J. Beauchamp, MD; Penelope M. Keyl, PhD; Daniel F. Hanley, MD Peter B. Barker, DPhil

From the Divisions of Neurosciences Critical Care (J.R.C., D.F.H.) and Neuroradiology (P.Y.W., N.J.B., P.B.B.) and the Department of Emergency Medicine (P.M.K.), The Johns Hopkins Medical Institutions, Baltimore, Md.

Correspondence to Juan R. Carhuapoma, MD, Division of Neurosciences Critical Care, Meyer 8–140, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-7840. E-mail jrcarhuapoma{at}sprintmail.com

Background and Purpose—Cerebral ischemia has been proposed as contributing mechanism to secondary neuronal injury after intracerebral hemorrhage (ICH). Possible tools for investigating this hypothesis are diffusion-weighted (DWI) and proton magnetic resonance spectroscopic imaging (¹H-MRSI). However, magnetic field inhomogeneity induced by paramagnetic blood products may prohibit the application of such techniques on perihematoma tissue. We report on the feasibility of DWI and ¹H-MRSI in the study of human ICH and present preliminary data on their contribution to understanding perihematoma tissue functional and metabolic profiles.

Methods—Patients with acute supratentorial ICH were prospectively evaluated using DWI and ¹H-MRSI. Obscuration of perihematoma tissue with both sequences was assessed. Obtainable apparent diffusion coefficient (Dav) and lactate spectra in perihematoma brain tissue were recorded and analyzed.

Results—Nine patients with mean age of 63.4 (36 to 87) years were enrolled. Mean time from symptom onset to initial MRI was 3.4 (1 to 9) days; mean hematoma volume was 35.4 (5 to 80) cm³. Perihematoma diffusion values were attainable in 9 of 9 patients, and ¹H-MRSI measures were obtainable in 5 of 9 cases. Dav in perihematoma regions was 172.5 (120.0 to 302.5)x10^-5 mm²/s and 87.6 (76.5 to 102.1)x10^-5 mm²/s in contralateral corresponding regions of interest (P=0.002). One patient showed an additional area of reduced Dav with normal T₂ intensity, which suggests ischemia. ¹H-MRSI revealed lactate surrounding the hematoma in 2 patients.

Conclusions—DWI and ¹H-MRSI can be used in the study of ICH patients. Our preliminary data are inconsistent with ischemia as the primary mechanism for perihematoma tissue injury. Further investigation with advanced MRI techniques will give a clearer understanding of the role that ischemia plays in tissue injury after ICH.

Key Words: intracerebral hemorrhage • magnetic resonance imaging, diffusion-weighted • neuronal damage • spectroscopy, nuclear magnetic resonance

This article has been cited by other articles:

				P. Delgado, E. Cuadrado, A. Rosell, J. Alvarez-Sabin, A. Ortega-Aznar, M. Hernandez-Guillamon, A. Penalba, C. A. Molina, and J. Montaner Fas System Activation in Perihematomal Areas After Spontaneous Intracerebral Hemorrhage Stroke, June 1, 2008; 39(6): 1730 - 1734. [Abstract] [Full Text] [PDF]

				R. Wada, R. I. Aviv, A. J. Fox, D. J. Sahlas, D. J. Gladstone, G. Tomlinson, and S. P. Symons CT Angiography "Spot Sign" Predicts Hematoma Expansion in Acute Intracerebral Hemorrhage Stroke, April 1, 2007; 38(4): 1257 - 1262. [Abstract] [Full Text] [PDF]

				NINDS ICH Workshop Participants Priorities for Clinical Research in Intracerebral Hemorrhage: Report From a National Institute of Neurological Disorders and Stroke Workshop Stroke, March 1, 2005; 36(3): e23 - e41. [Abstract] [Full Text] [PDF]

				W.-J. Moon, D. G. Na, S. S. Kim, J. W. Ryoo, and E. C. Chung Diffusion Abnormality of Deep Gray Matter in External Capsular Hemorrhage AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 229 - 235. [Abstract] [Full Text] [PDF]

				K. S. Butcher, T. Baird, L. MacGregor, P. Desmond, B. Tress, and S. Davis Perihematomal Edema in Primary Intracerebral Hemorrhage Is Plasma Derived Stroke, August 1, 2004; 35(8): 1879 - 1885. [Abstract] [Full Text] [PDF]

				P. D. Schellinger, J. B. Fiebach, K. Hoffmann, K. Becker, B. Orakcioglu, R. Kollmar, E. Juttler, P. Schramm, S. Schwab, K. Sartor, et al. Stroke MRI in Intracerebral Hemorrhage: Is There a Perihemorrhagic Penumbra? Stroke, July 1, 2003; 34(7): 1674 - 1679. [Abstract] [Full Text] [PDF]

				A. K. Kamal, J. P. Dyke, J. M. Katz, B. Liberato, C. G. Filippi, R. D. Zimmerman, and A. M. Ulug Temporal Evolution of Diffusion after Spontaneous Supratentorial Intracranial Hemorrhage AJNR Am. J. Neuroradiol., May 1, 2003; 24(5): 895 - 901. [Abstract] [Full Text] [PDF]

				S. A. Mayer Ultra-Early Hemostatic Therapy for Intracerebral Hemorrhage Stroke, January 1, 2003; 34(1): 224 - 229. [Abstract] [Full Text] [PDF]

				J. R. Carhuapoma, P. B. Barker, D. F. Hanley, P. Wang, and N. J. Beauchamp Human Brain Hemorrhage: Quantification of Perihematoma Edema by Use of Diffusion-Weighted MR Imaging AJNR Am. J. Neuroradiol., September 1, 2002; 23(8): 1322 - 1326. [Abstract] [Full Text] [PDF]

				J. Castillo, A. Davalos, J. Alvarez-Sabin, J. M. Pumar, R. Leira, Y. Silva, J. Montaner, and C.S. Kase Molecular signatures of brain injury after intracerebral hemorrhage Neurology, February 26, 2002; 58(4): 624 - 629. [Abstract] [Full Text] [PDF]

				G. Xi, Y. Hua, R. R. Bhasin, S. R. Ennis, R. F. Keep, and J. T. Hoff Mechanisms of Edema Formation After Intracerebral Hemorrhage: Effects of Extravasated Red Blood Cells on Blood Flow and Blood-Brain Barrier Integrity Stroke, December 1, 2001; 32(12): 2932 - 2938. [Abstract] [Full Text] [PDF]

				C. S. Kidwell, J. L. Saver, J. Mattiello, S. Warach, D. S. Liebeskind, S. Starkman, P. M. Vespa, J. P. Villablanca, N. A. Martin, J. Frazee, et al. Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage Neurology, November 13, 2001; 57(9): 1611 - 1617. [Abstract] [Full Text] [PDF]

				M. Kobayashi, H. Takayama, S. Suga, B. Mihara, G. A. Rosenberg, and W. M. Brooks Longitudinal Changes of Metabolites in Frontal Lobes After Hemorrhagic Stroke of Basal Ganglia: A Proton Magnetic Resonance Spectroscopy Study Editorial Comment: A Proton Magnetic Resonance Spectroscopy Study Stroke, October 1, 2001; 32(10): 2237 - 2245. [Abstract] [Full Text] [PDF]