Grund Benedikt, Ebert Anne, Sandikci Vesile, Neumaier-Probst Eva, Alonso Angelika
Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany.
Department of Neuroradiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
BMC Neurol. 2024 Dec 20;24(1):487. doi: 10.1186/s12883-024-03992-7.
Neuroimaging plays a vital role in the diagnosis of intracerebral hemorrhage (ICH) and in identifying the underlying etiology for appropriate therapeutic approach. This study aims to determine the significance and potential advantages of using early magnetic resonance imaging (MRI) as a diagnostic tool for ICH.
This retrospective study included 359 patients with ICH treated at the Department of Neurology, Mannheim University Hospital between January 2017 and December 2021. Patient characteristics, stroke severity and imaging procedures were descriptively analyzed. Factors associated with the choice of imaging modalities were evaluated. The etiology of hemorrhage was retrospectively analyzed using the existing data. We recorded the reassignment of ICH etiology by comparing the assessment after first sole review of CT scan and then subsequent MRI review. The overall rate of reassignments and the reassignments per CT-based initial etiology were analyzed.
In the sample of 359 patients with ICH (mean age 73.1 years, 55.4% male), patients receiving an additional MRI were significantly younger (p < .001) and were less severely affected by stroke (median NIHSS score 5 vs. 15, p < .001). MRI was performed significantly less frequently in patients who died during hospitalization (11.7% vs. 63.9%, p < .001). MRI led to a reassignment of ICH etiology in 48.2% of cases (80/166), uncovering unknown underlying causes in 69% of cases (49/71). Reassignment occurred most frequently in patients with a CT-based diagnosis of hypertensive ICH (18/50). The most frequent reassigned etiologies after MR imaging were cerebral amyloid angiopathy (CAA; 36 patients) and secondary hemorrhage of an ischemic stroke (30 patients).
Early MR imaging in patients with ICH improves the determination of underlying etiology and the conception of an appropriate treatment approach, potentially contributing to better patient outcomes.
神经影像学在脑出血（ICH）的诊断以及确定潜在病因以采取适当治疗方法方面发挥着至关重要的作用。本研究旨在确定使用早期磁共振成像（MRI）作为ICH诊断工具的意义和潜在优势。
这项回顾性研究纳入了2017年1月至2021年12月期间在曼海姆大学医院神经内科接受治疗的359例ICH患者。对患者特征、卒中严重程度和成像程序进行了描述性分析。评估了与成像方式选择相关的因素。利用现有数据对出血病因进行了回顾性分析。通过比较首次单独CT扫描评估和随后MRI评估后的结果，记录了ICH病因的重新分类情况。分析了重新分类的总体发生率以及基于CT的初始病因的重新分类情况。
在359例ICH患者样本中（平均年龄73.1岁，男性占55.4%），接受额外MRI检查的患者明显更年轻（p < 0.001），且卒中影响较轻（美国国立卫生研究院卒中量表（NIHSS）中位数评分5分对15分，p < 0.001）。在住院期间死亡的患者中，MRI检查的频率明显较低（11.7%对63.9%，p < 0.001）。MRI导致48.2%的病例（80/166）重新分类了ICH病因，在69%的病例（49/71）中发现了未知的潜在病因。重新分类在基于CT诊断为高血压性ICH的患者中最常见（18/50）。MRI成像后最常见的重新分类病因是脑淀粉样血管病（CAA；36例患者）和缺血性卒中继发性出血（30例患者）。
ICH患者的早期MRI成像可改善潜在病因的确定和适当治疗方法的制定，可能有助于改善患者预后。
