Diffusion Abnormality of Deep Gray Matter in External Capsular Hemorrhage
Won-Jin Moona,
Dong Gyu Nac,
Sam Soo Kimb,
Jae Wook Ryoob and
Eun Chul Chunga
a Department of Radiology, Kangbuk Samsung Hospital, Seoul, Korea
b Samsung Medical Center, Seoul, Korea
c Sungkyunkwan University School of Medicine, Seoul National University Hospital, Seoul, Korea
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FIG 1. Schematic classification of striatocapsular hemorrhage.
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FIG 2. Patient 1. A 33-year-old man with early chronic intracerebral hematoma on MR images obtained 40 days after symptom onset.
A, CT scan (left) 12 days after symptom onset shows a hyperattenuating hematoma primarily in the right external capsule between the lateral putamen and the insular cortex. T1-weighted image (middle) shows a hypointense cavitary lesion in the right external capsule. FLAIR image (right) reveals subtle hyperintensity of the deep gray matter in the caudate head, putamen, thalamus, and part of the insular cortex.
B, Diffusion-weighted image (left) shows obvious hyperintensity in the caudate head, putamen, and thalamus, which are separate from the hematoma itself. No other diffusion abnormality is seen. ADC map (right) shows decreased ADC in the caudate, putamen, and thalamus; ADC ratios relative to contralateral gray matter were 0.75, 0.79, and 0.80, respectively. This suggests that the diffusion abnormality is impaired intracellular diffusion rather than a T2 shine-through effect.
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FIG 3. Patient 8. A 66-year-old man with late subacute intracerebral hematoma on MR images obtained 30 days after symptom onset.
A, T1-weighted image (top left) shows hyperintensity of the hematoma mainly in the left external capsule area. Hematoma also extends into a part of the posterior angle of the putamen and insular cortex. T2-weighted image (top right) shows the hematoma as a hyperintense area circumscribed by a hypointense rim; this suggests subacute hematoma. Subtle hyperintensity is noted in the ipsilateral caudate head and putamen. DW image (bottom left) shows obvious hyperintensity in the caudate and putamen and mild hyperintensity in the thalamus. ADC map (bottom right) shows decreased ADC in the caudate, part of the putamen and medial-posterior thalamus; ADC ratios relative to the contralateral gray matter were 0.59, 0.61, and 0.87, respectively.
B, T2-weighted image (left) obtained 12 months later shows atrophy of the caudate and putamen, while the hematoma resolves to a slitlike cavity. Follow-up diffusion image (middle) reveals no definable signal intensity change in the caudate, putamen, or thalamus ipsilateral to the hematoma. Follow-up ADC map (right) shows normalization of ADC values in the corresponding deep gray matter.
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