title: Diffusion-weighted magnetic resonance imaging of organized subdural hematoma--case report.
abstract: A 59-year-old male presented with a left organized subdural hematoma. The hematoma appeared as a homogeneous low density area on brain computed tomography and as hyperintense and isointense area on both fluid-attenuated inversion recovery and T2-weighted magnetic resonance (MR) imaging. Echo-planar diffusion-weighted MR imaging showed a crescent hyperintense area under the dura mater and an irregular hypointense area over the brain surface in the left subdural space. The apparent diffusion coefficient (ADC) values of the solid and liquid hematoma were 0.86 +/- 0.32 x 10(-3) and 2.56 +/- 0.39 x 10(-3) mm2/sec, respectively. The ADC value of the solid hematoma was similar to acute subdural or intraparenchymal hematoma, and that of the liquid was similar to cerebrospinal fluid. Burr-hole surgery failed to remove all the hematoma, and he complained of persistent headache. The hematoma was removed through a craniotomy without further neurological deficits. Organized subdural hematoma often requires craniotomy for evacuation because of its solid content. Diffusion-weighted MR imaging and measurement of ADC values can differentiate solid from liquid hematoma, so are useful for selection of the surgical procedure.
authors.affiliation: Department of Neurosurgery, Kochi Gamma Knife Center, Mominoki Hospital, Kochi, Japan.
authors.forename: Seikou
authors.initials: S
authors.lastname: Kuwahara
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Miyake
authors.forename: Masaaki
authors.initials: M
authors.lastname: Fukuoka
authors.forename: Yoko
authors.initials: Y
authors.lastname: Koan
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.forename: Akihito
authors.initials: A
authors.lastname: Moriki
authors.forename: Koreaki
authors.initials: K
authors.lastname: Mori
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mokudai
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Uchida
mesh_terms: D003399:Craniotomy; D038524:Diffusion Magnetic Resonance Imaging; D017352:Echo-Planar Imaging; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014207:Trephining