Spontaneous Intracerebral Hematoma on Diffusion-weighted Images: Influence of T2-shine-through and T2-blackout Effects
Stéphane Silveraa,
Catherine Oppenheima,
Emmanuel Touzéb,
Denis Ducreuxa,
Philippe Pagec,
Valérie Domigob,
Jean-Louis Masb,
François-Xavier Rouxc,
Daniel Frédya and
Jean-François Medera
a Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Université Paris V, Paris, France
b Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris V, Paris, France
c Department of Neurosurgery, Centre Hospitalier Sainte-Anne, Université Paris V, Paris, France
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FIG 1. Manual contouring of the hematoma.
A, On the T2-weighted echo planar image (b = 0 mm2/s) on which the hematoma appears largest, the outer limit of the region of interest corresponded to the T2-hypointense ring.
B, The region of interest is copied on the diffusion-weighted image (b = 1000 mm2/s).
C, Mean absolute ADC values are computed in the region of interest. Mirror region of interest is placed on the contralateral hemisphere to compute the rADC.
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FIG 2. T2 shine-through (A, D) and T2 blackout effects (B, C) in intracerebral hematomas.
A, Hyperacute hematoma in a 28-year-old man. The frontal lobe hematoma is isointense on a T1-weighted, hyperintense on a fluid-attenuated inversion recovery (not shown), T2-weighted, and DW image acquired with low ADC values.
B, Acute hematoma in a 19-year-old woman. The right capsule–thalamic hematoma is isointense on a T1-weighted (not shown), hypointense on a T2-weighted, and hypointense on a DW image with low ADC values.
C, Early subacute hematoma in a 54-year-old man. The right parietal lobe hematoma is hyperintense on a T1-weighted (not shown), hypointense on a T2-weighted, and hypointense on a DW image acquired with low ADC values.
D, Late subacute hematoma in a 73-year-old man. The right temporo-occipital hematoma is hyperintense on a T1-weighted (not shown), hyperintense on a T2-weighted, and hyperintense on a DW image acquired with low ADC values.
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FIG 3. Signal intensity ratios according to the hematoma stages (mean ± SD). Throughout the course of the hematoma, the signal intensity ratio on DW (rSDW) and on T2-weighted echo planar (rST2) images are positively correlated (r = 0.93, P <.05).
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FIG 4. Signal intensity ratio on DW images (rSDW) and ADC ratio (rADC) according to the stage of intracerebral hematomas (mean ± SD).
While rSDW shows significant changes throughout the course of the hematoma, rADC values are moderately and significantly decreased throughout the course of hematoma (P < .001). No correlation is observed between rADC and rSDW (r = 0.09, P = .6).
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