Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
Division of Neurology, McMaster University & Population Health Research Institute, Hamilton, ON, Canada.
Eur Stroke J. 2023 Dec;8(4):1089-1096. doi: 10.1177/23969873231192761. Epub 2023 Aug 11.
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.
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 five studies total (four identified in the PubMed and EMBASE searches and our 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.
自发性脑出血（ICH）患者的脑部磁共振成像（MRI）诊断率尚不清楚。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 例连续自发性 ICH 患者。对入院和随访时的脑部 MRI 扫描进行了继发性病变评估。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 中搜索了关于自发性 ICH 脑部 MRI 继发性病变检出率的文章。
856 例 ICH 患者中，481 例（56%）至少进行了一次脑部 BRI[70±14 岁，270 例（56%）为男性]。462 例（54%）进行了入院 MRI 检查，138 例（16%）进行了入院和随访 MRI 检查。入院 MRI 上继发性病变的检出率为 24/462（5.2%）。4/127（3.1%）入院 MRI 阴性的患者在随访 MRI 上发现了病变。单变量分析中，无临床或影像学变量与 MRI 上的继发性病变相关。荟萃分析共纳入了五项研究（四项在 PubMed 和 EMBASE 检索中发现，以及我们的队列研究），共纳入了 1147 例接受脑部 MRI 检查的自发性 ICH 患者。汇总的继发性病变检出率为 11%（95%CI：7-16）。
我们的队列研究未发现继发性病变检出的预测因素。需要前瞻性研究来更好地了解 MRI 在自发性 ICH 中的诊断效用。
