DIAGNOSTIC NEURORADIOLOGY Temporal changes in perihematomal apparent diffusion coefficient values during the transition from acute to subacute phases in patients with spontaneous intracerebral hemorrhage Enrico Fainardi & Massimo Borrelli & Andrea Saletti & Silvio Sarubbo & Gloria Roversi & Andrea Bernardoni & Francesco Latini & Cristiano Azzini & Luca Borgatti & Alessandro De Vito & Michele Cavallo & Stefano Ceruti & Arturo Chieregato Received: 8 June 2012 / Accepted: 7 September 2012 / Published online: 18 September 2012 # Springer-Verlag 2012 Abstract Introduction Diffusion-weighted imaging (DWI) studies fo- cusing on apparent diffusion coefficient (ADC) abnormali- ties have provided conflicting results about the nature and fate of perihematomal edema. Methods We investigated 35 patients with supratentorial spontaneous intracerebral hemorrhage (SICH) by using DWI scanning obtained at 48 h and 7 days after symptom onset. Regional ADC (rADC) values were measured in three manually outlined regions of interest: (1) the perihematomal hyperintense area, (2) 1 cm of normal appearing brain tissue surrounding the perilesional hyperintense rim, and (3) a mirror area, including the clot and the perihematomal region, located in the contralateral hemisphere. Results rADC mean levels were lower at 7 days than at 48 h in each ROI (p <0.00001), showing a progressive normalization of initial vasogenic values. Perihematomal vasogenic rADC values were more frequent (p <0.00001) at 48 h than at 7 days, whereas perihematomal cytotoxic and normal rADC levels were more represented (p <0.02 and p <0.001, respectively) at 7 days than at 48 h. A neurological worsening was more frequent (p <0.02) in patients with than in those without perihematomal cytotoxic rADC values at 7 days. Conclusion Our findings suggest that the transition from acute to subacute phases after SICH is characterized by a progressive resolution of perihematomal vasogenic edema associated with an increase in cytotoxic ADC values. In the subset of patients with perihematomal cytotoxic rADC levels in subacute stage after bleeding, irreversible damage development seems to be related to poor clinical outcome. E. Fainardi (*) : M. Borrelli : A. Saletti : L. Borgatti : S. Ceruti Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Corso della Giovecca 203, 44100 Ferrara, Italy e-mail: henryfai@tin.it S. Sarubbo : F. Latini : M. Cavallo Neurosurgery Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria, Ferrara, Italy G. Roversi Section of Neurology, Department of Medical and Surgical Sciences of the Communication and Behaviour, University of Ferrara, Ferrara, Italy A. Bernardoni Section of Radiology, Department of Surgical, Anesthesiological and Radiological Sciences, University of Ferrara, Ferrara, Italy C. Azzini : A. De Vito Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy A. Chieregato Neurocritical Care Unit, Ospedale M. Bufalini, Cesena, Italy Neuroradiology (2013) 55:145–156 DOI 10.1007/s00234-012-1093-x