MRI identifies small vessel disease markers of haematoma expansion in ICH
medwireNews: Researchers are calling for a broader role for acute-phase magnetic resonance imaging (MRI) in patients with intracerebral haemorrhage (ICH) after finding it identifies features of small vessel disease that are independently associated with haematoma expansion.
The results for 254 patients with lobar ICH and 164 with deep ICH showed that cortical superficial siderosis (cSS) was independently associated with larger ICH volume in patients with lobar ICH, while the absence of cerebral microbleeds (CMBs) was associated with larger ICH volume in both groups and with haematoma expansion in patients with lobar ICH.
These MRI markers were associated with haematoma expansion independently of other known markers, such as presence of spot sign, more than 6 hours to final computed tomographic scan and intraventricular haemorrhage at baseline. The markers have been associated with both clinical and molecular imaging markers of small vessel disease severity in previous studies, note the researchers.
“Therefore, the findings are of key importance because they add insight to our understanding of ICH development and growth, linking the underlying [small vessel disease] severity with acute-phase features of brain hemorrhage”, they comment in JAMA Neurology.
They suggest that the presence of cSS indicates vessel fragility, and the odds of it being present in patients with lobar ICH increased 1.49-fold with each quintile increase in final ICH volume.
“Our results suggest that the presence of cSS identifies patients who once a vessel ruptures will experience the most bleeding, potentially from secondary ruptures or fragile vessels”, Joshua Goldstein (Harvard Medical School, Boston, Massachusetts, USA) and fellow researchers explain.
“It may be that the presence of cSS can mark those patients at highest risk of hematoma expansion in the hyperacute phase.”
The other major marker was the absence of accompanying CMBs, the odds of which were increased 1.41-fold in lobar ICH patients and 1.43-fold in deep ICH patients with each quintile increase in final ICH volume.
For the lobar ICH group, an absence of accompanying CMBs was also more likely in those with greater haematoma expansion, at an odds ratio of 1.70.
The seemingly counterintuitive finding of an absence, rather than presence, of CMBs being associated with larger ICHs was picked up in a related editorial by Eric Smith (University of Calgary, Alberta, Canada).
He explains that highly diseased small vessels become stiffened by collagen and fibrin deposition and “[t]herefore, the presence of CMBs may identify patients with thick vessel walls resistant to deformation and secondary rupture, while the absence of CMBs may mark patients with healthier but more deformable vessels that are more vulnerable, not less vulnerable, to secondary rupture.”
Goldstein et al believe their findings “suggest that there may be value in the use of acute-phase MRI in patients with ICH”, but Smith disagrees.
He says that “[w]hile MRI offers additional prognostic information that cannot be gleaned from [computed tomography], the clinical usefulness seems insufficient to abandon current [computed tomography]-based acute-phase ICH protocols for MRI-based protocols.”
By Lucy Piper
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