Functional diffusion map evaluation of perihematomal edema as an imaging biomarker for the early prediction of primary intracerebral hemorrhage outcome

Background Secondary neuronal injury in the perihematomal edema is one of the major factors that lead to the high morbidity and mortality in primary intracerebral hemorrhage (ICH). Diffusion magnetic resonance imaging (MRI) has been applied in studying perihematomal injury in patients with ICH but with inconstant results. Because the perihematomal injury should be complex and heterogeneous, different areas of edema with increasing and decreasing changes in diffusion would be masked in overall mean apparent diffusion coefficient (ADC). In contrast, functional diffusion maps (fDM) have been developed in which regional variations in diffusion, including both increasing and decreasing, can be quantified . In this prospective investigation, we estimate diffusion change in perihematomal edema during acute stage (within 7 days) after ICH by using fDM. We hypothesized that early diffusion changes in perihematomal edema correlate with clinical outcome in patients with ICH and that fDM approach could be used as a predictive imaging biomarker.