Wilson Mitch, Wang Jia-Yi, Andreev Alexander, Katsanos Aristeidis H, Selim Magdy, Lioutas Vasileios-Arsenios
medRxiv. 2023 Apr 25:2023.04.19.23288843. doi: 10.1101/2023.04.19.23288843.
The diagnostic yield of brain Magnetic Resonance Imaging (MRI) in spontaneous intracerebral hemorrhage (ICH) is unclear. We performed both an independent single-center retrospective cohort study and a meta-analysis to assess the detection rate of secondary lesions on MRI in patients with spontaneous ICH.
In the retrospective cohort study, we examined 856 consecutive patients with spontaneous ICH. Brain MRI scans on admission and follow-up were assessed for secondary lesions. We also examined clinical and CT radiographic variables associated with secondary lesions in univariable analysis. In the meta-analysis we searched PubMed and EMBASE for articles investigating the secondary lesion detection rate on brain MRI in spontaneous ICH. Random-effects models were used to calculate the pooled estimate of secondary lesion detection rate. The meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Of the 856 patients with ICH, 481 (56%) had at least one brain BRI performed [70±14 years, 270(56% male)]. 462(54%) had an admission MRI and 138(16%) had both admission and follow-up MRIs. The detection rate of secondary lesions on admission MRIs was 24/462(5.2%). 4/127(3.1%) patients with a negative admission MRI had a lesion identified on follow-up MRI. No clinical or radiographic variables were associated with a secondary lesion on MRI using univariable analysis. The meta-analysis included 5 studies total (4 identified in the PubMed and EMBASE searches as well as our own cohort study) comprising 1147 patients with spontaneous ICH who underwent brain MRI. The pooled detection rate of secondary lesions was 11% (95%CI: 7-16%).
No predictors of secondary lesion detection were identified in our cohort study. Prospective studies are required to better understand the diagnostic utility of MRI in spontaneous ICH.
脑磁共振成像（MRI）在自发性脑出血（ICH）中的诊断价值尚不清楚。我们进行了一项独立的单中心回顾性队列研究和一项荟萃分析，以评估自发性ICH患者MRI上继发性病变的检出率。
在回顾性队列研究中，我们检查了856例连续的自发性ICH患者。对入院时和随访时的脑部MRI扫描进行继发性病变评估。我们还在单变量分析中检查了与继发性病变相关的临床和CT影像学变量。在荟萃分析中，我们在PubMed和EMBASE上搜索了研究自发性ICH患者脑部MRI继发性病变检出率的文章。采用随机效应模型计算继发性病变检出率的合并估计值。荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。
在856例ICH患者中，481例（56%）至少进行了一次脑部MRI检查[年龄70±14岁，270例（56%为男性）]。462例（54%）进行了入院时MRI检查，138例（16%）进行了入院时和随访时的MRI检查。入院时MRI上继发性病变的检出率为24/462（5.2%）。127例入院时MRI检查阴性的患者中有4例（3.1%）在随访时MRI检查发现病变。单变量分析未发现任何临床或影像学变量与MRI上的继发性病变相关。荟萃分析共纳入5项研究（在PubMed和EMBASE搜索中确定的4项研究以及我们自己的队列研究），包括1147例接受脑部MRI检查的自发性ICH患者。继发性病变的合并检出率为11%（95%CI：7-16%）。
在我们的队列研究中未发现继发性病变检出的预测因素。需要进行前瞻性研究以更好地了解MRI在自发性ICH中的诊断效用。
