Dotlike hemosiderin spots on T2*-weighted magnetic resonance imaging as a predictor of stroke recurrence: a prospective study

Toshio Imaizumi M.D., Ph.D. 1 , Yoshifumi Horita M.D. 1 , Yuji Hashimoto M.D., Ph.D. 1 and Jun Niwa M.D., Ph.D. 1
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  • 1 Department of Neurosurgery, Hakodate Municipal Hospital, Hokkaido, Japan
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Object. Microangiopathy associated with hypertension is a notable cause of cerebral small vessel disease (SVD), including deep intracerebral hemorrhage (ICH) and lacunar infarct. Dotlike low-intensity spots (dotlike hemosiderin spots: dotHSs) on T2*-weighted magnetic resonance (MR) images have been histologically diagnosed as old cerebral microbleeds associated with lipohyalinosis, amyloid angiopathy, or other microangiopathies and located in deep or subcortical regions. The aim of this study was to determine whether dotHSs indicate the severity of microangiopathy, and if so, whether large numbers of deep dotHSs are associated with SVD recurrence.

Methods. The authors prospectively analyzed the number of dotHSs in 337 patients—191 men and 146 women with a mean age of 66 ± 10.4 years (range 37–94 years)—with SVD (199 ICHs and 138 lacunar infarcts) who had been consecutively admitted to Hakodate Municipal Hospital. The follow-up period was 3.5 to 42 months (22.5 ± 13.1 months). Patients were divided into two groups based on the recurrence. The hazard ratio (HR) for recurrence was estimated based on the Cox proportional hazard model by using the number of deep and subcortical dotHSs as well as other factors. Of 337 patients, 20 were readmitted with recurrence. Results of a multivariate analysis revealed an elevated rate of recurrence in patients with many subcortical dotHSs (≥ 5, HR 4.36, p = 0.0019) or a history of ICH (HR 3.82, p = 0.014). A trend toward a positive correlation (Pearson correlation coefficient 0.548, p < 0.0001) was found between the number of deep and subcortical dotHSs.

Conclusions. Although a small sample size limited the power of analyses, the findings indicate that a large number of subcortical dotHSs may predict SVD recurrence.

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Contributor Notes

Address reprint requests to: Toshio Imaizumi, M.D., Ph.D., Department of Neurosurgery, Kushiro City General Hospital, 1–12 Shunkodai, Kushiro, Hokkaido 085–0822, Japan. email: timaizum@d9.dion.ne.jp.
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