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Research ArticleAdult Brain

Acute Cytotoxic and Vasogenic Edema after Subarachnoid Hemorrhage: A Quantitative MRI Study

J.M. Weimer, S.E. Jones and J.A. Frontera
American Journal of Neuroradiology May 2017, 38 (5) 928-934; DOI: https://doi.org/10.3174/ajnr.A5181
J.M. Weimer
aFrom the Cerebrovascular Center of the Neurological Institute (J.M.W., J.A.F.)
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S.E. Jones
bthe Imaging Institute (S.E.J.), Cleveland Clinic, Cleveland, Ohio.
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J.A. Frontera
aFrom the Cerebrovascular Center of the Neurological Institute (J.M.W., J.A.F.)
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Article Figures & Data

Figures

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  • Fig 1.
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    Fig 1.

    Composite histogram curves from all patients plotting fractions of voxels by voxel intensity in apparent diffusion coefficient maps of controls (line) and subjects with SAH (dots).

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    Fig 2.

    Composite histogram curves from all patients with SAH plotting the fraction of voxels by voxel intensity in apparent diffusion coefficient maps of patients with SAH with Hunt and Hess 1–3 (line) and Hunt and Hess 4–5 (dots).

Tables

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    Table 1:

    Summary of admission, demographic, clinical, and radiographic characteristics of patients with SAHa

    Patients with SAH (n = 33)Controls (n = 66)P Value
    Basic and demographic data
        Age (yr)59 (44.5–66)49 (43.4–53.2)<.001b
        Female sex16 (48.5%)41 (62.1%).196
        Race
            Caucasian25 (75.8%)47 (72.3%).343
            Black8 (24.3%)14 (21.5%)
            Other04 (6.2%)
        History of smoking21 (63.6%)34 (51.5%).253
        History of alcohol abuse7 (22.6%)10 (15.2%).370
        Hypertension14 (45.2%)33 (50.0%).657
        Diabetes4 (12.9%)14 (21.2%).326
        Hyperlipidemia12 (38.7%)24 (36.4%).824
        Aspirin use10 (31.3%)22 (33.3%).837
        History of ischemic stroke1 (3.0%)0–
        History of intracranial hemorrhage00–
        History of head trauma00–
        History of brain tumor00–
        Family history of aneurysm4 (13.3%)0–
        Cocaine use within 24 hr of ictus1 (3.0%)0–
    Admission clinical and radiographic data
        Premorbid modified Rankin Scale score290 (0–0)
        HH grade12
            15 (15.2%)
            214 (42.4%)
            36 (18.2%)
            45 (15.2%)
            53 (9.1%)
        Glasgow Coma Score15 (11.5–15)
        APACHE II score307 (3–10)
        Modified Fisher grade15
            14 (12.1%)
            22 (6.1%)
            318 (54.5%)
            49 (27.3%)
        Hijdra sum score3113.5 (6–21)
        Cerebral edema on admission CT8 (25.0%)
        External ventricular drain placed14 (42.4%)
    • Note:—APACHE II indicates Acute Physiology and Chronic Health Evaluation II.

    • ↵a Values are reported as No. (%) or median (interquartile range). Comparative basic and demographic data are provided for controls.

    • ↵b Statistical significance.

    • View popup
    Table 2:

    Average median ADC values in ROIs in patients with SAH and controlsa

    ROIADC (×10−6 mm2/s) Control (n = 66)ADC (×10−6 mm2/s) SAH (n = 33)P ValueAge-Adjusted P Value
    Cerebral gray matter803 (36.2)826 (37.7).001b.059
        Frontal802 (65.2)823 (66.4).137
        Parietal820 (48.0)843 (53.5).025b
        Occipital798 (67.7)814 (51.7).042b
        Temporal791 (43.6)822 (60.6).006b
    Cerebral white matter758 (33.9)793 (44.9).001b.023b
        Frontal735 (53.0)768 (55.8).007b
        Parietal767 (50.9)799 (51.3).007b
        Occipital764 (36.8)795 (47.7).003b
        Temporal767 (45.4)809 (61.8).003b
    White matter tracts739 (33.5)797 (59.3)<.001b<.001b
        Genu761 (45.2)816 (69.1)<.001b
        Splenium736 (45.6)789 (91.4)<.001b
        Internal capsule719 (53.2)785 (96.4)<.001b
    Deep gray matter713 (27.4)754 (59.6)<.001b.016b
        Thalamus730 (45.1)777 (86.8).020b
        Caudate705 (37.2)739 (65.7).002b
        Lentiform705 (45.5)747 (67.5)<.001b
    Hippocampus854 (67.7)878 (64.8).072
    Midbrain795 (93.5)813 (47.4).006b
    Pons706 (50.6)756 (54.6)<.001b
    Cerebellar gray matter756 (48.9)796 (67.7).001
    Cerebellar white matter720 (50.3)731 (43.7).214
    Summed ROIs759 (23.3)795 (36.9)<.00b<.001b
    • ↵a Values are reported as average median with SD.

    • ↵b Statistical significance.

    • View popup
    Table 3:

    Average median ADC values in ROIs among patients with SAH with HH 1–3 versus 4–5a

    ROIADC (×10−6 mm2/s) HH 1–3 (n = 25)ADC (×10−6 mm2/s) HH 4–5 (n = 8)P Value
    Cerebral gray matter823 (25.9)833 (64.1).159
        Frontal821 (60.9)831 (85.9).785
        Parietal844 (55.4)843 (50.6).753
        Occipital813 (41.0)819 (80.3).556
        Temporal816 (52.1)840 (83.5).172
    Cerebral white matter787 (43.1)811 (48.7).147
        Frontal764 (57.2)781 (52.6).425
        Parietal801 (49.8)792 (58.7)1.000
        Occipital789 (45.8)814 (51.6).115
        Temporal793.5 (55.4)856 (59.7).014b
    White matter tracts796 (58.4)798 (66.1).916
        Genu810 (63.5)834 (86.6).401
        Splenium799 (79.1)758 (123.8).950
        Internal capsule780 (103.7)801 (71.9).401
    Deep gray matter748 (52.1)773 (80.0).074
        Thalamus763 (81.4)820 (94.7).097
        Caudate737 (57.8)743 (90.8).130
        Lentiform744 (64.4)756 (80.7).239
    Hippocampus881 (62.9)870 (74.4)1.000
    Midbrain811 (43.2)818 (61.9).378
    Pons756 (50.3)756 (70.4).834
    Cerebellar gray matter794 (75.5)800 (36.8).324
    Cerebellar white matter730 (45.6)732 (39.5).883
    Summed ROIs792 (31.7)803 (51.7).200
    • ↵a Values are reported as average median with SDs.

    • ↵b Statistical significance.

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American Journal of Neuroradiology: 38 (5)
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J.M. Weimer, S.E. Jones, J.A. Frontera
Acute Cytotoxic and Vasogenic Edema after Subarachnoid Hemorrhage: A Quantitative MRI Study
American Journal of Neuroradiology May 2017, 38 (5) 928-934; DOI: 10.3174/ajnr.A5181

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Acute Cytotoxic and Vasogenic Edema after Subarachnoid Hemorrhage: A Quantitative MRI Study
J.M. Weimer, S.E. Jones, J.A. Frontera
American Journal of Neuroradiology May 2017, 38 (5) 928-934; DOI: 10.3174/ajnr.A5181
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