Chalouhi Nohra, Mouchtouris Nikolaos, Al Saiegh Fadi, Das Somnath, Sweid Ahmad, Flanders Adam E, Starke Robert M, Baldassari Michael P, Tjoumakaris Stavropoula, Gooch Michael Reid, Shah Syed Omar, Hasan David, Herial Nabeel, D'Ambrosio Robin, Rosenwasser Robert, Jabbour Pascal
Departments of1Neurosurgery and.
2Radiology, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
J Neurosurg. 2019 May 31;132(6):1865-1871. doi: 10.3171/2019.2.JNS183425. Print 2020 Jun 1.
MRI and MRA studies are routinely obtained to identify the etiology of intracerebral hemorrhage (ICH). The diagnostic yield of MRI/MRA in the setting of an acute ICH, however, remains unclear. The authors' goal was to determine the utility of early MRI/MRA in detecting underlying structural lesions in ICH and to identify patients in whom additional imaging during hospitalization could safely be foregone.
The authors reviewed data obtained in 400 patients with spontaneous ICH diagnosed on noncontrast head CT scans who underwent MRI/MRA between 2015 and 2017 at their institution. MRI/MRA studies were reviewed to identify underlying lesions, such as arteriovenous malformations, aneurysms, cavernous malformations, arteriovenous fistulas, tumors, sinus thrombosis, moyamoya disease, and abscesses.
The median patient age was 65 ± 15.8 years. Hypertension was the most common (72%) comorbidity. Structural abnormalities were detected on MRI/MRA in 12.5% of patients. Structural lesions were seen in 5.7% of patients with basal ganglia/thalamic ICH, 14.1% of those with lobar ICH, 20.4% of those with cerebellar ICH, and 27.8% of those with brainstem ICH. Notably, the diagnostic yield of MRI/MRA was 0% in patients > 65 years with a basal ganglia/thalamic hemorrhage and 0% in those > 85 years with any ICH location, whereas it was 37% in patients < 50 years and 23% in those < 65 years. Multivariate analysis showed that decreasing age, absence of hypertension, and non-basal ganglia/thalamic location were predictors of finding an underlying lesion.
The yield of MRI/MRA in ICH is highly variable, depending on patient age and hemorrhage location. The findings of this study do not support obtaining early MRI/MRA studies in patients ≥ 65 years with basal ganglia/thalamic ICH or in any ICH patients ≥ 85 years. In all other situations, early MRI/MRA remains valuable in ruling out underlying lesions.
常规进行磁共振成像（MRI）和磁共振血管造影（MRA）检查以确定脑出血（ICH）的病因。然而，急性脑出血情况下MRI/MRA的诊断价值仍不明确。作者的目标是确定早期MRI/MRA在检测脑出血潜在结构病变方面的效用，并确定住院期间可安全免去额外影像学检查的患者。
作者回顾了2015年至2017年在其机构接受MRI/MRA检查的400例经非增强头部CT扫描诊断为自发性脑出血患者的数据。对MRI/MRA检查结果进行回顾，以确定潜在病变，如动静脉畸形、动脉瘤、海绵状畸形、动静脉瘘、肿瘤、窦血栓形成、烟雾病和脓肿。
患者中位年龄为65±15.8岁。高血压是最常见的合并症（72%）。12.5%的患者在MRI/MRA上检测到结构异常。基底节/丘脑脑出血患者中5.7%发现结构病变，脑叶脑出血患者中14.1%，小脑出血患者中20.4%，脑干脑出血患者中27.8%。值得注意的是，65岁以上基底节/丘脑出血患者的MRI/MRA诊断率为0%，85岁以上任何脑出血部位患者的诊断率为0%，而50岁以下患者为37%，65岁以下患者为23%。多因素分析显示，年龄降低、无高血压以及非基底节/丘脑部位是发现潜在病变的预测因素。
ICH患者中MRI/MRA的检出率差异很大，取决于患者年龄和出血部位。本研究结果不支持对65岁及以上基底节/丘脑ICH患者或任何85岁及以上ICH患者进行早期MRI/MRA检查。在所有其他情况下，早期MRI/MRA在排除潜在病变方面仍有价值。
