McKinney Hudson, Kirk Bryan A, Jailwala Anuj J, McFarlane Aaron, Sullivan Jackson L, Agarwal Raghav, Hiatt Kevin D
Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Emerg Radiol. 2025 May 20. doi: 10.1007/s10140-025-02348-z.
Hypertensive hemorrhage is the most common type of nontraumatic intracerebral hemorrhage (ICH), and it characteristically originates in deep structures, particularly the basal ganglia, internal capsules, thalami, brainstem, and cerebellum. While advanced imaging modalities like MRI can help uncover culprit lesions in cases of unexplained ICH, we hypothesized that the yield of brain MRI would be low in patients with spontaneous deep intracerebral hemorrhage.
With IRB approval, we retrospectively reviewed cases of deep ICH at a single tertiary care academic center over a 5-year period and excluded cases with a known cause for hemorrhage. Patient history and demographics, initial blood pressure, and the results of the initial noncontrast head CT and subsequent imaging studies were recorded.
222 patients met study inclusion criteria, with a median age of 67 and 43.2% female sex. 188 patients (84.7%) had a history of hypertension, while 14 (6.3%) had a urine drug screen positive for cocaine or amphetamines during their hospital admission. The majority of hemorrhages were centered in the basal ganglia or internal capsules (116, 52.3%). Brain MRI was obtained for 120 (54.1%) of cases at a median interval of 0.97 days following the initial head CT, and of these studies, 85 (70.8%) included postcontrast imaging. Only 1 MRI study (0.8%) identified a culprit lesion adjacent to a cerebellar hematoma, which was later found to represent a pilocytic astrocytoma. 33.8% of patients overall met the modified Hong Kong Rule. Of the 77 MRIs performed in patients not meeting the modified Hong Kong Rule, 0 revealed a culprit lesion.
Brain MRI obtained in the acute evaluation of patients with spontaneous deep intracerebral hemorrhage rarely uncovers a culprit lesion. Routine ordering of MRI in this cohort should be reconsidered, particularly in patients not meeting the modified Hong Kong Rule.
高血压性脑出血是最常见的非创伤性脑出血（ICH）类型，其特征性地起源于深部结构，尤其是基底节、内囊、丘脑、脑干和小脑。虽然像MRI这样的先进成像方式有助于在不明原因的ICH病例中发现罪魁祸首病变，但我们推测自发性深部脑出血患者的脑部MRI检出率会很低。
经机构审查委员会（IRB）批准，我们回顾性分析了一家三级医疗学术中心5年内深部ICH的病例，并排除了有已知出血原因的病例。记录患者病史和人口统计学资料、初始血压以及初始非增强头部CT和后续影像学检查的结果。
222例患者符合研究纳入标准，中位年龄为67岁，女性占43.2%。188例患者（84.7%）有高血压病史，14例（6.3%）在住院期间尿液药物筛查显示可卡因或苯丙胺呈阳性。大多数出血集中在基底节或内囊（116例，52.3%）。120例（54.1%）病例在初始头部CT后中位间隔0.97天进行了脑部MRI检查，其中85例（70.8%）包括增强后成像。只有1例MRI检查（0.8%）发现小脑血肿附近有一个罪魁祸首病变，后来发现是毛细胞型星形细胞瘤。总体而言，33.8%的患者符合改良香港规则。在不符合改良香港规则的患者中进行的77次MRI检查中，无一发现罪魁祸首病变。
在自发性深部脑出血患者的急性评估中进行的脑部MRI很少能发现罪魁祸首病变。应重新考虑在这一队列中常规安排MRI检查，特别是在不符合改良香港规则的患者中。
