Diffusion-weighted imaging provides support for secondary neuronal damage from intraparenchymal hematoma

It is controversial whether an intracerebral hematoma (ICH) causes ischemia of surrounding brain. By virtue of its high sensitivity to acute cerebral infarction, diffusion-weighted imaging (DWI) helps answer this question. We used this technique to assess the parenchyma surrounding ICH for restricted diffusion. Echoplanar DWI (b 1000 s/mm²) and conventional MRI sequences were performed in 30 subjects (symptom duration 7–75 h) with primary ICH, mean volume: 13±15 cm³. We calculated mean apparent diffusion coefficients (ADC) within high signal regions around the hematoma on DWI or T2-weighted images and within the ICH itself, comparing them to the contralateral brain. We used the Student's t -test to examine for differences between these regions and linear regression to relate changes to the age of the ICH. A thin rim of high signal on DWI and a wider rim on T2-weighted images surrounded all hematomas. The ADC within the rim on DWI showed a maximum reduction of 40%, in two patients imaged within 10 h of symptom onset. They rose during the first day (r²=0.84; P <0.03) and then showed a mild decrease, becoming the same as ADC in other areas of the brain (r²=0.5; P <0.03). The rim on T2-weighting showed a mean increase of 50% and ADC within the ICH were reduced by a mean of 38%; these variations showed no relationship with ICH age and no group showed any relationship with ICH size. The ADC within the three regions was significantly different from each other. The presence of restricted diffusion in the parenchyma surrounding ICH provides support for secondary neuronal damage.