Diffusion measurements in intracranial hematomas: implications for MR imaging of acute stroke.

BACKGROUND AND PURPOSE The purpose of our study was to analyze the diffusion properties of intracranial hematomas to understand the effects of hematomas on diffusion-weighted MR images of patients with acute stroke and to further our understanding of the evolution of signal intensities of hematomas on conventional MR images. We hypothesized that hematomas containing blood with intact RBC membranes (ie, early hematomas) have restricted diffusion compared with hematomas in which RBC membranes have lysed. METHODS Seventeen proven intracranial hematomas were studied with conventional and diffusion MR imaging. Hematomas were characterized using conventional images to determine the stage of evolution and their putative biophysical composition, as described in the literature. Apparent diffusion coefficient (ADC) measurements for each putative hematoma constituent (intracellular oxyhemoglobin, intracellular deoxyhemoglobin, intracellular methemoglobin, and extracellular methemoglobin) were compared with each other and with normal white matter. RESULTS Hematomas showing hemoglobin within intact RBCs by conventional MR criteria (n = 14) showed equivalent ADC values, which were reduced compared with hematomas containing lysed RBCs (P = .0029 to .024). Compared with white matter, hematomas containing lysed RBCs had higher ADC measurements (P = .003), whereas hematomas containing intact RBCs had reduced ADC measurements (P < .0001). CONCLUSION Restricted diffusion is present in early intracranial hematomas in comparison with both late hematomas and normal white matter. Therefore, early hematomas would be displayed as identical to the signal intensity of acute infarction on ADC maps, despite obvious differences on conventional MR images. These data also are consistent with the biochemical composition that has been theorized in the stages of evolving intracranial hematomas and provide further evidence that paramagnetic effects, rather than restriction of water movement, are the dominant cause for their different intensity patterns on conventional MR images.

[1]  C. Beaulieu,et al.  Longitudinal magnetic resonance imaging study of perfusion and diffusion in stroke: Evolution of lesion volume and correlation with clinical outcome , 1999, Annals of neurology.

[2]  G. Albers,et al.  Expanding the window for thrombolytic therapy in acute stroke. The potential role of acute MRI for patient selection. , 1999, Stroke.

[3]  J S Lewin,et al.  Hyperacute stroke: ultrafast MR imaging to triage patients prior to therapy. , 1999, Radiology.

[4]  P D Lyden,et al.  Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy. , 1999, Stroke.

[5]  W. Shabana,et al.  Use of diffusion-weighted MR imaging in differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. , 1999, AJNR. American journal of neuroradiology.

[6]  L H Schwamm,et al.  Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. , 1999, Radiology.

[7]  S W Atlas,et al.  MR detection of hyperacute parenchymal hemorrhage of the brain. , 1998, AJNR. American journal of neuroradiology.

[8]  P. Petrozza.  Diffusion-weighted MRI in acute subcortical infarction , 1998 .

[9]  M. Kaibara.  Rheology of blood coagulation. , 1995, Biorheology.

[10]  Koroshetz Wj,et al.  Tissue plasminogen activator for acute ischemic stroke. , 1996, The New England journal of medicine.

[11]  Joseph P. Broderick,et al.  Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. , 1995 .

[12]  B. Siewert,et al.  Acute human stroke studied by whole brain echo planar diffusion‐weighted magnetic resonance imaging , 1995, Annals of neurology.

[13]  R D Tien,et al.  MR imaging of high-grade cerebral gliomas: value of diffusion-weighted echoplanar pulse sequences. , 1994, AJR. American journal of roentgenology.

[14]  K. Svoboda,et al.  Time-dependent diffusion of water in a biological model system. , 1994, Proceedings of the National Academy of Sciences of the United States of America.

[15]  P. Basser,et al.  MR diffusion tensor spectroscopy and imaging. , 1994, Biophysical journal.

[16]  J. Creyghton,et al.  Diffusion in red blood cell suspensions: Separation of the intracellular and extracellular NMR sodium signal , 1993, Magnetic resonance in medicine.

[17]  Wei Li,et al.  Fast magnetic resonance diffusion‐weighted imaging of acute human stroke , 1992, Neurology.

[18]  L. Hedlund,et al.  Mechanism of Detection of Acute Cerebral Ischemia in Rats by Diffusion‐Weighted Magnetic Resonance Microscopy , 1992, Stroke.

[19]  J. Frahm,et al.  Diffusion imaging of the human brain in vivo using high‐speed STEAM MRI , 1992, Magnetic resonance in medicine.

[20]  T. Asakura,et al.  Morphology of sickle cells produced in solutions of varying osmolarities. , 1991, The Journal of laboratory and clinical medicine.

[21]  Bruce R. Rosen,et al.  MR Diffusion Imaging of the Human Brain , 1990, Journal of computer assisted tomography.

[22]  J. Kurhanewicz,et al.  Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. , 1990, AJNR. American journal of neuroradiology.

[23]  Rachael,et al.  Acute hematomas: effects of deoxygenation, hematocrit, and fibrin-clot formation and retraction on T2 shortening. , 1990, Radiology.

[24]  R. Bryant,et al.  Magnetic relaxation in blood and blood clots , 1990, Magnetic resonance in medicine.

[25]  R. Grossman,et al.  Intracranial hematomas: imaging by high-field MR. , 1985, Radiology.

[26]  R. Grossman,et al.  High-field MR imaging of superficial siderosis of the central nervous system. , 1985, Journal of computer assisted tomography.

[27]  W G Bradley,et al.  Effect of methemoglobin formation on the MR appearance of subarachnoid hemorrhage. , 1985, Radiology.

[28]  G. Radda,et al.  Oxygenation dependence of the transverse relaxation time of water protons in whole blood at high field. , 1982, Biochimica et biophysica acta.

[29]  A R Hargens,et al.  Sickle-cell hemoglobin: fall in osmotic pressure upon deoxygenation. , 1980, Proceedings of the National Academy of Sciences of the United States of America.

[30]  C. Hazlewood,et al.  Nuclear magnetic resonance patterns of intracellular water as a function of HeLa cell cycle. , 1976, Science.

[31]  C. D. Coryell,et al.  The Magnetic Properties and Structure of Hemoglobin, Oxyhemoglobin and Carbonmonoxyhemoglobin , 1936, Proceedings of the National Academy of Sciences.