Boulanger Marion, Schneckenburger Romain, Join-Lambert Claire, Werring David J, Wilson Duncan, Hodel Jérome, Zuber Mathieu, Touzé Emmanuel
From the Normandie University, UNICAEN, Inserm U1237, Caen, France (M.B., M.Z., E.T.).
CHU Côte de Nacre, Neurology Department, Caen, France (M.B., R.S., E.T.).
Stroke. 2019 Jan;50(1):135-142. doi: 10.1161/STROKEAHA.118.021407. Epub 2018 Dec 7.
Background and Purpose- Diffusion-weighted imaging (DWI) hyperintensities in intracerebral hemorrhage (ICH) are associated with increased risk of recurrent ICH, cognitive impairment, and death, but whether these lesions are specific to a subtype of ICH remains uncertain. We investigated the association between DWI lesions and ICH subtype and explored the risk factors for DWI lesions. Methods- In a systematic review of ICH studies, we identified those reporting prevalence of DWI lesions. Two reviewers independently assessed study eligibility and risk of bias and collected data. We determined the pooled prevalence of DWI lesions within 90 days after ICH onset for cerebral amyloid angiopathy- and hypertensive angiopathy-related ICH using random-effects meta-analysis. We calculated odds ratios to compare prevalence of DWI lesions by ICH subtype and to assess risk factors for DWI lesions. Results- Eleven studies (1910 patients) were included. The pooled prevalence of DWI lesions was 18.9% (95% CI, 11.1-26.7) in cerebral amyloid angiopathy- and 21.0% (95% CI, 15.3-26.6) in hypertensive angiopathy-related ICH. There was no difference in the prevalence of DWI lesions between cerebral amyloid angiopathy- (64/292 [21.9%]) and hypertensive angiopathy-related ICH (79/370 [21.4%]; odds ratio, 1.25; 95% CI, 0.73-2.15) in the 5 studies reporting data on both ICH pathogeneses. In all ICH, presence of DWI lesions was associated with neuroimaging features of microangiopathy (leukoaraiosis extension, previous ICH, and presence, and number of microbleeds) but not with vascular risk factors or the use of antithrombotic therapies. Conclusions- Prevalence of DWI lesions in acute ICH averages 20%, with no difference between cerebral amyloid angiopathy- and hypertensive angiopathy-related ICH. Detection of DWI lesions may add valuable information to assess the progression of the underlying microangiopathy.
背景与目的——脑出血（ICH）中的弥散加权成像（DWI）高信号与脑出血复发、认知障碍及死亡风险增加相关，但这些病灶是否为特定脑出血亚型所特有仍不确定。我们研究了DWI病灶与ICH亚型之间的关联，并探讨了DWI病灶的危险因素。方法——在一项对ICH研究的系统评价中，我们确定了报告DWI病灶患病率的研究。两名研究者独立评估研究的纳入资格和偏倚风险并收集数据。我们采用随机效应荟萃分析确定了脑淀粉样血管病和高血压性血管病相关ICH发病后90天内DWI病灶的合并患病率。我们计算比值比以比较不同ICH亚型的DWI病灶患病率，并评估DWI病灶的危险因素。结果——纳入11项研究（1910例患者）。脑淀粉样血管病中DWI病灶的合并患病率为18.9%（95%CI，11.1 - 26.7），高血压性血管病相关ICH中为21.0%（95%CI，15.3 - 26.6）。在5项报告了两种ICH发病机制数据的研究中，脑淀粉样血管病相关ICH（64/292 [21.9%]）和高血压性血管病相关ICH（79/370 [21.4%]；比值比，1.25；95%CI，0.73 - 2.15）的DWI病灶患病率无差异。在所有ICH中，DWI病灶的存在与微血管病的神经影像学特征（白质疏松扩展、既往ICH以及微出血的存在和数量）相关，但与血管危险因素或抗栓治疗的使用无关。结论——急性ICH中DWI病灶的患病率平均为20%，脑淀粉样血管病相关ICH和高血压性血管病相关ICH之间无差异。DWI病灶的检测可能为评估潜在微血管病的进展增加有价值的信息。
