Diffusion-Weighted Imaging Hyperintensities in Acute and Subacute-Phase Intracerebral Hemorrhage

Yuji Shiga; Shiro Aoki; Saki Tasaka; Jun Takeshita; Teppei Kamimura; Naoyuki Hara; Ryo Shimomura; Hayato Matsushima; Masahiro Nakamori; Tomohisa Nezu; Eiji Imamura; Tatsuya Mizoue; Shinichi Wakabayashi; Hirofumi Maruyama

doi:10.1016/j.jstrokecerebrovasdis.2022.106549

Diffusion-Weighted Imaging Hyperintensities in Acute and Subacute-Phase Intracerebral Hemorrhage

J Stroke Cerebrovasc Dis. 2022 Aug;31(8):106549. doi: 10.1016/j.jstrokecerebrovasdis.2022.106549. Epub 2022 May 12.

Authors

Affiliations

¹ Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
² Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: shirou@hiroshima-u.ac.jp.
³ Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
⁴ Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
⁵ Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan; Department of Neurology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
⁶ Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan; Department of Neurology, Chugoku Rosai Hospital, Kure, Japan.
⁷ Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan.

PMID: 35569404
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106549

Abstract

Objective: Diffusion-weighted imaging hyperintensities are observed in intracerebral hemorrhage patients at times and might be associated with unfavorable functional outcomes. However, the suitable time to evaluate diffusion-weighted imaging hyperintensities to influence stroke outcome remains unclear. This study investigated the associations between acute and sub-acute diffusion-weighted imaging hyperintensities and functional outcomes among patients with acute intracerebral hemorrhage.

Methods: Diffusion-weighted imaging hyperintensities were evaluated within 24 h (acute phase) and at 14 ± 5 days (sub-acute phase). An unfavorable functional outcome was a score of 5-6 on the modified Rankin Scale at 3 months.

Results: Among 268 intracerebral hemorrhage patients, diffusion-weighted imaging hyperintensities in the acute phase were observed in 32 (11.9%). Among 227 patients who underwent a second magnetic resonance imaging in the sub-acute phase, diffusion-weighted imaging hyperintensities were observed in 57 (25.1%). Multivariable analysis revealed that the baseline intracerebral hemorrhage volume, history of stroke, and severe white matter lesions were associated with sub-acute diffusion-weighted imaging hyperintensities. The patients with unfavorable outcomes (n = 37) had a higher frequency of sub-acute diffusion-weighted imaging hyperintensities than those without (n = 190) (51.4% vs. 20.0%, P < 0.001); the frequencies of acute diffusion-weighted imaging hyperintensities were not significantly different between the groups (13.5% vs. 10.0%, P = 0.559). Sub-acute diffusion-weighted imaging hyperintensities were independently associated with unfavorable outcomes after adjusting for confounding factors (Odds Ratio, 3.35, 95% CI 1.20-9.35, P = 0.021).

Conclusion: The rate of sub-acute diffusion-weighted imaging hyperintensities was higher than acute diffusion-weighted imaging hyperintensities among acute intracerebral hemorrhage patients and likely to be associated with unfavorable outcomes.

Keywords: Diffusion-weighted imaging; Intracerebral hemorrhage; Outcome; Subacute phase.

MeSH terms

Cerebral Hemorrhage* / diagnostic imaging
Diffusion Magnetic Resonance Imaging
Humans
Magnetic Resonance Imaging
Stroke* / diagnostic imaging