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MRI of intracerebral hematoma: value of vasogenic edema ratio for predicting the cause

  • Diagnostic Neuroradiology
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Abstract

We evaluated a method for quantifying vasogenic edema (VE) on MRI to identify brain hematomas caused by neoplasms. We performed a blinded review of 68 acute and subacute hematomas caused by neoplasms (22), hypertension or presumed amyloid angiopathy (27), or vascular malformations (19). The extent of vasogenic edema was quantified on an axial T2-weighted image using the VE ratio: the maximum width of high signal surrounding a hematoma and the mean diameter of the hematoma. Hematomas caused by neoplasm were associated with more vasogenic edema (mean VE ratio 104%±15%; mean VE width 2.4±0.7 cm) than non-neoplastic hematomas (mean VE ratio 37%±5%; P =0.001). When the width of VE was equal to or more half the diameter the hematoma (VE ratio 50%), the positive predictive value for tumor was 66%; when it was equal to or more than the diameter, the positive predictive value was 71%. All six hematomas with VE ratios ≥150% were caused by neoplasm.

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References

  1. Adams R, Victor M, Ropper A (1997) Principles of neurology, 6th edn. McGraw-Hill, New York, pp 834–841

  2. Mutlu N, Berry R, Alpers B (1963) Massive cerebral hemorrhage. Clinical and pathological correlation. Arch Neurol 8: 644–661

    Google Scholar 

  3. Scott M (1975) Spontaneous intracerebral hematoma caused by cerebral neoplasms. J Neurosurg 42: 338–342

    CAS  PubMed  Google Scholar 

  4. Griffiths P, Beveridge C, Gholkar A (1997) Angiography in non-traumatic brain hematoma. Acta Radiol 38: 797–802

    CAS  PubMed  Google Scholar 

  5. Dylewski D, Morgenstern L, Demchuk A (2000) Utility of magnetic resonance imaging in acute intracerebral hemorrhage. J Neuroimaging 10: 78–83

    CAS  PubMed  Google Scholar 

  6. Bradley W (1993) MR appearance of hemorrhage in the brain. Radiology 189: 15–26

    PubMed  Google Scholar 

  7. Osborn A (1994) Diagnostic neuroradiology. Mosby-Yearbook, St Louis, pp 166–167

  8. Nussbaum E, Heros R, Camarata R (1995) Surgical treatment of intracranial arteriovenous malformations with an analysis of cost-effectiveness. Clin Neurosurg 42: 348–369

    CAS  PubMed  Google Scholar 

  9. Duffau H, Capelle L, Sichez JP, et al (1997) Early radiologically proven rebleeding from intracranial cavernous angiomas: report of 6 cases and review of the literature. Acta Neurochir (Wien) 139: 914–922

    Google Scholar 

  10. Atlas S, Grossman R, Gomori J, et al (1987) Hemorrhagic intracranial malignant neoplasms: spin-echo MR imaging. Radiology 164: 71–77

    CAS  PubMed  Google Scholar 

  11. Inzitari D, Giordano G, Ancona A, Pracucci G, Mascalchi M, Amaducci L (1990) Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension. Stroke 21: 1419–1423

    CAS  PubMed  Google Scholar 

  12. Chappell P, Steinberg G, Marks M (1992) Clinically documented hemorrhage in cerebral arteriovenous malformations: MR characteristics. Radiology 183: 719–724

    CAS  PubMed  Google Scholar 

  13. Greenberg S, Finkelstein D, Schaefer P (1996) Petechial hemorrhages accompanying lobar hemorrhage: detection by gradient-echo MRI. Neurology 46: 1741–1754

    PubMed  Google Scholar 

  14. Offenbacher H, Fazekas F, Schmidt R, Koch M, Fazekas G, Kapeller P (1996) MR of cerebral abnormalities concomitant with primary intracerebral hematomas. AJNR 17: 573–578

    CAS  Google Scholar 

  15. Tanaka A, Ueno Y, Nakayama Y, Takano K, Takebayashi S (1999) Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. Stroke 30: 1637–1642

    CAS  PubMed  Google Scholar 

  16. Wakai S, Yamakawa K, Manaka S, Takakura K (1982) Spontaneous intracranial hemorrhage caused by brain tumor. Its incidence and clinical significance. Neurosurgery 10: 437–444

    CAS  PubMed  Google Scholar 

  17. Zimmerman H (1984) The pathology of primary brain tumors. Semin Roentgenol 19: 129–138

    CAS  PubMed  Google Scholar 

  18. Berkman R, Merrill M, Reinhold W, et al (1993) Expression of vascular permeability factor/vascular endothelial growth factor gene in central nervous system neoplasms. J Clin Invest 91: 153–159

    CAS  PubMed  Google Scholar 

  19. Strugar J, Criscuolo G, Rothbart D, Harrington W (1995) Vascular endothelial growth/permeability factor expression in human glioma specimens: correlation with vasogenic brain edema and tumor-associated cysts. J Neurosurg 83: 682–689

    Google Scholar 

  20. McLone D (1980) Ultrastructure of the vasculature of central nervous system tumors of childhood. Child's Brain 6: 242–254

    Google Scholar 

  21. Criscuolo G (1993) The genesis of peritumoral vasogenic brain edema and tumor cysts: a hypothetical role for tumor-derived vascular permeability factor. Yale J Biol Med 66: 277–314

    CAS  PubMed  Google Scholar 

  22. Little J, Dial B, Belanger G, Carpenter S (1979) Brain hemorrhage from intracranial tumor. Stroke 10: 283–288

    CAS  PubMed  Google Scholar 

  23. Zimmerman R, Bilaniuk L (1980) Computed tomography of acute intratumoral hemorrhage. Radiology 135: 355–359

    CAS  PubMed  Google Scholar 

  24. Senger D, Brown L, Claffey K, Dvorak H (1994) Vascular permeability factor, tumor angiogenesis and stroma generation. Invasion Metastasis 14: 385–394

    CAS  PubMed  Google Scholar 

  25. Earnest FT, Kelly P, Scheithauer B, et al (1988) Cerebral astrocytomas: histopathologic correlation of MR and CT contrast enhancement with stereotactic biopsy. Radiology 166: 823–827

    PubMed  Google Scholar 

  26. Coakley K, Huston Jr, Scheithauer B, Forbes G, Kelly P (1995) Pilocytic astrocytomas: well-demarcated magnetic resonance appearance despite frequent infiltration histologically. Mayo Clin Proc 70: 747–751

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Brown Medical School and Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island, 02903, USA

    G. A. Tung, B. D. Julius & J. M. Rogg

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  1. G. A. Tung
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  2. B. D. Julius
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  3. J. M. Rogg
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Correspondence to G. A. Tung.

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Tung, G.A., Julius, B.D. & Rogg, J.M. MRI of intracerebral hematoma: value of vasogenic edema ratio for predicting the cause. Neuroradiology 45, 357–362 (2003). https://doi.org/10.1007/s00234-003-0994-0

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  • DOI: https://doi.org/10.1007/s00234-003-0994-0

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