Correlation of vascular endothelial growth factor with magnetic resonance imaging in chronic subdural hematomas.

BACKGROUND: Chronic subdural hematoma (CSDH) is an inflammatory angiogenic disease. It is believed that vascular endothelial growth factor (VEGF) plays an important role in pathological CSDH angiogenesis.

METHODS: In this study, magnetic resonance imaging (MRI) results were used to assign 115 primary CSDH patients to four MRI types. The four MRI types are described as follows: type 1 (T1-weighted low, T2-weighted low), type 2 (T1-weighted high, T2-weighted low), type 3 (T1-weighted mixed, T2-weighted mixed), and type 4 (T1-weighted low/high, T2-weighted high). The four MRI types were then correlated with CSDH stage and patient hematoma fluid and serum VEGH concentrations that were measured using an enzyme-linked immunosorbent assay (ELISA). Neurological status was assessed by Markwalder scoring at admission and six-month follow-up.

RESULTS: The mean VEGF concentration was significantly higher in CDSH hematoma fluid samples than in patient sera (p<0.01). In unilateral CSDH hematoma fluid samples, VEGF concentration was highest in type 1 (21,613.5±1473.3pg/ml), next highest in type 2 (18,071.8±1737.1pg/ml), lower in type 3, and lowest in type 4 patients (13,153.7±3854.4pg/ml, 7265.7±726.2pg/ml, respectively). High VEGF concentrations strongly correlated with MRI type (unilateral CSDH group r=0.838, bilateral CSDH group r=0.851, p<0.01). Moreover, higher hematoma fluid VEGF concentrations correlated with markedly higher recurrence in type 1 (3/19, 15.8%) vs. type 4 unilateral CSDH patients (1/27, 3.7%).

CONCLUSIONS: The present study reports a significant correlation between CSDH hematoma fluid VEGF concentration and MRI results. Therefore, MRI results could be used to predict hematoma fluid VEGF concentrations in CSDH patients.