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Research ArticleBRAIN

Diffusion Abnormality of Deep Gray Matter in External Capsular Hemorrhage

Won-Jin Moon, Dong Gyu Na, Sam Soo Kim, Jae Wook Ryoo and Eun Chul Chung
American Journal of Neuroradiology February 2005, 26 (2) 229-235;
Won-Jin Moon
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Dong Gyu Na
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Sam Soo Kim
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Jae Wook Ryoo
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Eun Chul Chung
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Article Figures & Data

Figures

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  • Fig 1.
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    Fig 1.

    Schematic classification of striatocapsular hemorrhage.

  • Fig 2.
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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.

Tables

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    TABLE 1:

    Clinicoradiologic data in patients with diffusion abnormality remote from ICH

    Patient/Sex/Age (y)Time after ICH (days)Location of ICHTreatmentHyperintensity
    DWIFLAIR Imaging
    1/M/3340R ECSurgicalC, P, T, SNC, P, T, SN
    2/M/5227L ECSurgicalC, P, TC, P, T
    3/F/5528R ECSurgicalC, T, SNC, T
    4/M/5124R ECConservativePP
    5/F/518R ECSurgicalC, PC, P
    6/F/7854L ECConservativeC, TC, T
    7/M/7017L EC/TSurgicalC, PC, P
    8/M/6630L ECSurgicalC, P, TC, P, T
    9/M/7416R ECConservativeC, P, TC, P, T
    • Note.—C is the caudate nucleus head; EC, external capsule; P, putamen; SN, substantia nigra; and T, thalamus.

    • View popup
    TABLE 2:

    Relationship between DWI abnormality and interval after hemorrhage onset

    Interval (days)DWI Finding
    AbnormalNormalTotal
    0–3044
    4–7055
    8–307411
    31–60202
    61 or more066
    Total91928
    • View popup
    TABLE 3:

    Relationship between DWI abnormality and location of the hemorrhage

    LocationDWI Finding
    AbnormalNormalTotal
    Lateral9716
    Posterolateral01010
    Anterior022
    Total91928
    • View popup
    TABLE 4:

    Relationship between DWI abnormality and ADC change

    Location and DWI FindingADC (10−6 mm/s)ADC RatioP Value
    Caudate.000
        Abnormal (n = 8)582 ± 1350.76 ± 0.10
        Normal (n = 19)857 ± 1521.03 ± 0.18
    Putamen.000
        Abnormal (n = 8)612 ± 680.79 ± 0.07
        Normal (n = 19)821 ± 1511.04 ± 0.13
    Thalamus.028
        Abnormal (n = 5)650 ± 680.85 ± 0.11
        Normal (n = 22)820 ± 751.00 ± 0.07
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American Journal of Neuroradiology: 26 (2)
American Journal of Neuroradiology
Vol. 26, Issue 2
1 Feb 2005
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Diffusion Abnormality of Deep Gray Matter in External Capsular Hemorrhage
Won-Jin Moon, Dong Gyu Na, Sam Soo Kim, Jae Wook Ryoo, Eun Chul Chung
American Journal of Neuroradiology Feb 2005, 26 (2) 229-235;

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Diffusion Abnormality of Deep Gray Matter in External Capsular Hemorrhage
Won-Jin Moon, Dong Gyu Na, Sam Soo Kim, Jae Wook Ryoo, Eun Chul Chung
American Journal of Neuroradiology Feb 2005, 26 (2) 229-235;
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