title: Voxel-based analysis of apparent diffusion coefficient in perihaematomal oedema: associated factors and outcome predictive value for intracerebral haemorrhage.
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.
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China.
authors.forename: Yuan-Hsiung
authors.initials: YH
authors.lastname: Tsai
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Hsu
authors.forename: Hsu-Huei
authors.initials: HH
authors.lastname: Weng
authors.forename: Ming-Hsueh
authors.initials: MH
authors.lastname: Lee
authors.forename: Jen-Tsung
authors.initials: JT
authors.lastname: Yang
authors.forename: Ching-Po
authors.initials: CP
authors.lastname: Lin
references.citation: Stroke. 2003 Jul;34(7):1674-9
references.pmid: 12805502
references.citation: Acta Neurochir Suppl. 2006;96:81-4
references.pmid: 16671431
references.citation: Stroke. 2000 Mar;31(3):726-32
references.pmid: 10700511
references.citation: Stroke. 2003 Jul;34(7):1680
references.pmid: 12805501
references.citation: Stroke. 2004 Aug;35(8):1879-85
references.pmid: 15178826
references.citation: Stroke. 2010 Nov;41(11):2681-3
references.pmid: 20947849
references.citation: Lancet Neurol. 2006 Jan;5(1):53-63
references.pmid: 16361023
references.citation: Neuroradiology. 2002 Nov;44(11):907-11
references.pmid: 12428124
references.citation: Neurology. 2009 Dec 8;73(23):1963-8
references.pmid: 19996072
references.citation: Neurology. 2001 Nov 13;57(9):1611-7
references.pmid: 11706101
references.citation: AJNR Am J Neuroradiol. 2003 May;24(5):895-901
references.pmid: 12748091
references.citation: Neurocrit Care. 2008;8(3):448-55
references.pmid: 18188706
references.citation: Stroke. 2007 Mar;38(3):1072-5
references.pmid: 17290026
references.citation: AJNR Am J Neuroradiol. 2002 Sep;23(8):1322-6
references.pmid: 12223372
references.citation: J Cereb Blood Flow Metab. 2001 Jul;21(7):804-10
references.pmid: 11435792
references.citation: Stroke. 2004 Nov;35(11):2571-5
references.pmid: 15472083
references.citation: Neuroradiology. 2003 Jun;45(6):363-7
references.pmid: 12719952
references.citation: Stroke. 2011 Jan;42(1):73-80
references.pmid: 21164136