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Penckofer M, Kazmi KS, Thon J, Tonetti DA, Ries C, Rajagopalan S. Neuro-imaging in intracerebral hemorrhage: updates and knowledge gaps. Front Neurosci 2024; 18:1408288. [PMID: 38784090 PMCID: PMC11111865 DOI: 10.3389/fnins.2024.1408288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Intracerebral hemorrhage (ICH) is characterized by hematoma development within the brain's parenchyma, contributing significantly to the burden of stroke. While non-contrast head computed tomography (CT) remains the gold standard for initial diagnosis, this review underscores the pivotal role of magnetic resonance imaging (MRI) in ICH management. Beyond diagnosis, MRI offers invaluable insights into ICH etiology, prognosis, and treatment. Utilizing echo-planar gradient-echo or susceptibility-weighted sequences, MRI demonstrates exceptional sensitivity and specificity in identifying ICH, aiding in differentiation of primary and secondary causes. Moreover, MRI facilitates assessment of hemorrhage age, recognition of secondary lesions, and evaluation of perihematomal edema progression, thus guiding tailored therapeutic strategies. This comprehensive review discusses the multifaceted utility of MRI in ICH management, highlighting its indispensable role in enhancing diagnostic accuracy as well as aiding in prognostication. As MRI continues to evolve as a cornerstone of ICH assessment, future research should explore its nuanced applications in personalized care paradigms.
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Affiliation(s)
- Mary Penckofer
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Khuram S. Kazmi
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neuroradiology, Cooper University Health Care, Camden, NJ, United States
| | - Jesse Thon
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurology, Cooper University Health Care, Camden, NJ, United States
| | - Daniel A. Tonetti
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurosurgery, Cooper University Health Care, Camden, NJ, United States
| | - Casey Ries
- Department of Radiology, Cooper University Health Care, Camden, NJ, United States
| | - Swarna Rajagopalan
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurology, Cooper University Health Care, Camden, NJ, United States
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Wilson M, Wang JY, Andreev A, Katsanos AH, Selim M, Lioutas VA. Diagnostic utility of brain MRI in spontaneous intracerebral hemorrhage: A retrospective cohort study and meta-analysis. Eur Stroke J 2023; 8:1089-1096. [PMID: 37571850 PMCID: PMC10683734 DOI: 10.1177/23969873231192761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION 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. PATIENTS AND METHODS 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. RESULTS 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). DISCUSSION AND CONCLUSION 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.
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Affiliation(s)
- Mitch Wilson
- Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Jia-Yi Wang
- Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Alexander Andreev
- Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University & Population Health Research Institute, Hamilton, ON, Canada
| | - Magdy Selim
- Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Vasileios-Arsenios Lioutas
- Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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Wilson M, Wang JY, Andreev A, Katsanos AH, Selim M, Lioutas VA. Diagnostic Utility of Brain MRI in Spontaneous Intracerebral Hemorrhage: A Retrospective Cohort Study and Meta-Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.19.23288843. [PMID: 37163063 PMCID: PMC10168433 DOI: 10.1101/2023.04.19.23288843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background 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. Methods 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. Random-effects models were used to calculate the pooled estimate of secondary lesion detection rate. The meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results 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 5 studies total (4 identified in the PubMed and EMBASE searches as well as our own 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%). Conclusions 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.
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Zhou H, Cha Z, Wang L, Chen M, Zhang Q, Tang J. Clinical efficacy and safety of neuroendoscopic surgery for severe thalamic hemorrhage with ventricle encroachment. Neurosurg Rev 2022; 45:2701-2708. [PMID: 35381930 DOI: 10.1007/s10143-022-01782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022]
Abstract
To summarize and analyze the clinical efficacy and safety of neuroendoscopic surgery (NES) in the treatment of patients for severe thalamic hemorrhage with ventricle encroachment (THVE). Eighty-three patients with severe THVE were treated in the Neurosurgery Department of Anqing Hospital Affiliated to Anhui Medical University from July 2019 to August 2021. Our study was approved by the ethics committee. The patients were randomly divided into NES group and extraventricular drainage (EVD) group. The hospital stay, Glasgow coma scale (GCS) scores on the 1st and 14th days postoperatively, the incidence of intracranial infections, and the clearance of postoperative hematomas were compared and analyzed between the two groups. The patients had follow-up evaluations 6 months postoperatively. The prognosis was evaluated based on the activity of daily living (ADL) score. A head CT or MRI was obtained to determine whether there was hydrocephalus, cerebral infarction, or other related complications. Eighty-three patients were randomly divided into 41 cases of NES group and 42 cases of EVD group. The length of postoperative hospital stay was 17.42 ± 1.53 days, the GCS scores were 6.56 ± 0.21, and 10.83 ± 0.36 on days 1 and 14, respectively; intracranial infections occurred in 3 patients (7.31%) and the hematoma clearance rate was 83.6 ± 5.18% in the NES group, all of which were significantly better than the EVD group (P < 0.05). After 6 months of follow-up, 28 patients (68.29%) had a good prognosis, 5 patients (12.19%) died, and 4 patients (9.75%) had hydrocephalus in the NES group. In the EVD group, the prognosis was good in 15 patients (35.71%), 12 patients (28.57%) died, and 17 patients (40.47%) had hydrocephalus. The prognosis, mortality rate, and incidence of hydrocephalus in the NES group were significantly better than the EVD group (P < 0.05). Compared to traditional EVD, NES for severe THVE had a higher hematoma clearance rate, and fewer intracranial infections and patients with hydrocephalus, which together improve the clinical prognosis and is thus recommended for clinical use.
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Affiliation(s)
- Heping Zhou
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China.
| | - Zhengjiang Cha
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China
| | - Lei Wang
- Department of Neurology, Anqing Hospital Affiliated to Anhui Medical University, Anqing, Anhui Province, People's Republic of China
| | - Min Chen
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China
| | - Qingchao Zhang
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China
| | - Jian Tang
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, 246003, Anhui Province, People's Republic of China
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Frequency, Predictors, Etiology, and Outcomes for Deep Intracerebral Hemorrhage without Hypertension. J Stroke Cerebrovasc Dis 2022; 31:106293. [PMID: 35016096 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Some patients with deep intracerebral hemorrhage (ICH) have a transient hypertensive response and they may be erroneously classified as secondary to hypertension. We investigated frequency, risk factors, and outcomes for patients with deep ICH without hypertension. MATERIALS AND METHODS We consecutively recruited patients with spontaneous ICH attending two Spanish stroke centers (January 2015-June 2019). Excluded were patients with lobar/infratentorial ICH and patients who died during hospitalization. We defined deep ICH without hypertension when the bleeding was in a deep structure, no requirement for antihypertensive agents during follow-up and no evident chronic hypertension markers evaluated by transthoracic echocardiography, 24 h ambulatory blood pressure monitoring and/or electrocardiography. We compared clinical, radiological, and 3-month functional outcome data for deep-ICH patients with hypertension versus those without hypertension. RESULTS Of 759 patients with ICH, 219 (mean age 69.6 ± 15.4 years, 54.8% men) met the inclusion criteria and 36 (16.4%) did not have hypertension. Of these 36 patients, 19 (52.7%) had a transient hypertensive response. Independent predictors of deep ICH without hypertension were age (adjusted OR:0.94;95%CI:0.91-0.96) and dyslipidemia (adjusted OR:0.27;95% CI:0.08-0.85). One third of deep ICH without hypertension were secondary to vascular malformations. Favorable outcomes (modified Rankin Scale 0-2) were more frequent in patients with deep ICH without hypertension compared to those with hypertension (70.9% vs 33.8%; p < 0.001). CONCLUSION Of patients with deep ICH, 16.4% were unrelated with hypertension, around half showed hypertensive response, and around a third had vascular malformations. We suggest studying hypertension markers and performing a follow-up brain MRI in those patients with deep ICH without prior hypertension.
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Dundamadappa SK. Nontraumatic brain parenchymal hemorrhage: The usual suspects and more. Clin Imaging 2022; 83:99-122. [PMID: 35032839 DOI: 10.1016/j.clinimag.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/23/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
Brain parenchymal hemorrhage is a common neuroimaging finding in an emergency room. It is considered primary in the absence of an underlying lesion or coagulopathy. Secondary hemorrhages are caused by various structural causes and pathologies. The goals of imaging are to identify the hematoma, assess factors that have prognostic significance, assess associated complications, identify an underlying etiology whenever possible, and guide therapeutic decisions. The review provides an illustrative review of various etiologies of non-traumatic brain parenchymal hemorrhage and their imaging evaluation.
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Affiliation(s)
- Sathish Kumar Dundamadappa
- Umass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01655, United States of America.
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Wei JH, Tian YN, Zhang YZ, Wang XJ, Guo H, Mao JH. Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int racerebral hemorrhage. World J Clin Cases 2021; 9:8358-8365. [PMID: 34754845 PMCID: PMC8554417 DOI: 10.12998/wjcc.v9.i28.8358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/02/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system, comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate. It severely affects the patients’ quality of life.
AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.
METHODS From March 2018 to May 2020, 118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan. The control group used a hard-channel minimally invasive puncture and drainage procedure. The observation group underwent minimally invasive neuroendoscopic surgery. The changes in the levels of serum P substances (SP), inflammatory factors [tumor necrosis factor-α, interleukin-6 (IL-6), IL-10], and the National Hospital Stroke Scale (NIHSS) and Barthel index scores were recorded. Surgery related indicators and prognosis were compared between the two groups.
RESULTS The operation time (105.26 ± 28.35) of the observation group was min longer than that of the control group, and the volume of intraoperative bleeding was 45.36 ± 10.17 mL more than that of the control group. The hematoma clearance rates were 88.58% ± 4.69% and 94.47% ± 4.02% higher than those of the control group at 48 h and 72 h, respectively. Good prognosis rate (86.44%) was higher in the observation group than in the control group, and complication rate (5.08%) was not significantly different from that of the control group (P > 0.05).The SP level and Barthel index score of the two groups increased (P < 0.05) and the inflammatory factors and NIHSS score decreased (P < 0.05). The cytokine levels, NIHSS score, and Barthel index score were better in the observation group than in the control group (P < 0.05).
CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage; however, hematoma clearance is more thorough, and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.
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Affiliation(s)
- Jian-Hui Wei
- Department of Neurosurgery, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Ya-Nan Tian
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Ya-Zhao Zhang
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Xue-Jing Wang
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Hong Guo
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Jian-Hui Mao
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
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Abstract
Primary or nontraumatic spontaneous intracerebral hemorrhage (ICH) comprises approximately 15% to 20% of all stroke. ICH has a mortality of approximately 40% within the first month, and 75% mortality and morbidity rate within the first year. Despite reduction in overall stroke incidence, hemorrhagic stroke incidence has remained steady since 1980. Neuroimaging is critical in detection of ICH, determining the underlying cause, identification of patients at risk of hematoma expansion, and directing the treatment strategy. This article discusses the neuroimaging methods of ICH, imaging markers for clinical outcome prediction, and future research directions with attention to the latest evidence-based guidelines.
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Affiliation(s)
- Abhi Jain
- Department of Radiology, Einstein Healthcare Network, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Ajay Malhotra
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, Tompkins East TE-2, New Haven, CT 06520, USA
| | - Seyedmehdi Payabvash
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, Tompkins East TE-2, New Haven, CT 06520, USA.
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