Acute-stage diffusion-weighted magnetic resonance imaging for predicting outcome of poor-grade aneurysmal subarachnoid hemorrhage.
We investigated the role of acute-stage diffusion-weighted images (DWIs) for predicting outcome of poor-grade subarachnoid hemorrhage (SAH). This study included 38 patients with poor-grade SAH who underwent DWI within 24 h after onset. DWI findings were divided into three groups on the basis of lesion area: none (N), spotty (S, <or=10 mm(2)), or areal (A, >10 mm(2)). We evaluated the correlation between preoperative DWI findings and clinical outcome, and the characteristics of DWI abnormalities. DWI abnormalities were revealed in 81.6% of cases (group S 34.2%; group A 47.3%). All patients in groups N and S and 73.3% of patients in group A were treated radically. For those patients without rerupture, favorable outcomes were achieved in 100% of group N, 53.8% of group S, and 0% of group A. Abnormal lesions on initial DWI, which resulted in permanent lesions, showed a mean apparent diffusion coefficient ratio to the control value of 0.71, which was significantly lower than 0.95 observed in reversible lesions (P<0.01). We recommend radical treatment for even poor-grade SAH as long as the preoperative DWI shows no or only spotty lesions. DWI may provide an objective means to estimate the outcome of poor-grade SAH.
Sato
Kenichi
K
Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Taihaku-ku, Japan. satoken@kohnan-sendai.or.jp
Shimizu
Hiroaki
H
Fujimura
Miki
M
Inoue
Takashi
T
Matsumoto
Yasushi
Y
Tominaga
Teiji
T
D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000401:mortality; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality