Analysis of the utility of early MRI/MRA in 400 patients with spontaneous intracerebral hemorrhage

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  • 1 Departments of Neurosurgery and
  • 2 Radiology, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania;
  • 3 Department of Neurosurgery and Radiology, Miami Miller School of Medicine, Miami University Hospital, Miami, Florida; and
  • 4 Department of Neurosurgery, University of Iowa, Iowa City, Iowa
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OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

ABBREVIATIONS AUC = area under the curve; AVM = arteriovenous malformation; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage.

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Contributor Notes

Correspondence Pascal Jabbour: Thomas Jefferson University Hospital, Philadelphia, PA. pascal.jabbour@jefferson.edu.

INCLUDE WHEN CITING Published online May 31, 2019; DOI: 10.3171/2019.2.JNS183425.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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