Imaging lesions could reveal insights into hemorrhage outcomes
Overview
A prospective cohort study found that diffusion-weighted imaging (DWI)-positive lesions are associated with a greater burden of cerebral small vessel disease and worse functional outcomes at 6 months in patients with acute intracerebral hemorrhage (ICH). The study analyzed 342 patients and identified significant correlations between DWI-positive lesions and various clinical factors.
Background
Intracerebral hemorrhage (ICH) is a severe form of stroke, with high mortality and disability rates. Understanding the imaging characteristics associated with ICH can help in predicting outcomes. Recent studies have highlighted the importance of diffusion-weighted imaging in assessing cerebral small vessel disease.
Data Highlights
| Characteristic | DWI-positive lesions | DWI-negative lesions |
|---|---|---|
| Prevalence | 22% (n = 74) | 78% (n = 268) |
| Median ICH volume | 14 mL | 7 mL |
| Median cerebral microbleed burden | 3 | 1 |
| Recurrent stroke | 20% | 6% |
| Mortality | 14% | 5% |
Key Findings
- DWI-positive lesions were found in 22% of patients with ICH.
- 53% of patients with DWI-positive lesions had white matter lesions.
- Severe white matter hyperintensities occurred in 81% of patients with DWI-positive lesions.
- Previous stroke or transient ischemic attack, ICH volume ≥30 mL, severe white matter hyperintensities, and ≥5 cerebral microbleeds were independently associated with DWI-positive lesions.
- DWI-positive lesions were associated with approximately twice the odds of dependence or mortality at 6 months.
Clinical Implications
The presence of DWI-positive lesions may indicate a higher burden of cerebral small vessel disease. Clinicians should consider these imaging findings when assessing prognosis.
Conclusion
The study indicates that DWI-positive lesions are significant markers of cerebral small vessel disease burden and are associated with poorer functional outcomes in patients with acute ICH.
Related Resources & Content
- Locatelli M, et al., Neurology, 2023 -- DWI-Positive Lesions in Patients With Acute Intracerebral Hemorrhage: Associations With Cerebral Small Vessel Disease and Clinical Outcome.
- European Radiology — Predictive Features of Non-contrast CT for Growth of Intraventricular Hemorrhage
- Frontiers in Neurology — Imaging studies for predicting hematoma expansion: from traditional imaging signs to artificial intelligence-based multimodal fusion
- Frontiers in Neurology — Imaging patterns of hemorrhagic transformation after tenecteplase versus alteplase in real-world practice
- European Radiology — Collateral Mapping: Forecasting Lesion Expansion and Penumbral Area Following Acute Anterior Circulation Ischemic Stroke
- 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage
- Diagnosis and management of cerebral amyloid angiopathy: a scientific statement from the International CAA Association and the World Stroke Organization
- oup.silverchair-cdn.com
- DWI-Positive Lesions in Patients With Acute Intracerebral Hemorrhage: Associations With Cerebral Small Vessel Disease and Clinical Outcome.
- DWI-Positive Lesions in Acute Intracerebral Hemorrhage and Their Correlation With Small Vessel Disease: A Cohort Study - PMC
- Acute Blood Pressure Lowering and Risk of Ischemic Lesions on MRI After Intracerebral Hemorrhage | Trials | JAMA Neurology | JAMA Network
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