Diagnostic utility of brain MRI in spontaneous intracerebral hemorrhage: A retrospective cohort study and meta-analysis

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.

Neuro-imaging in intracerebral hemorrhage: updates and knowledge gaps

“…If the initial MRI does not reveal an underlying etiology of the ICH, a follow-up MRI could be useful to alter future management. Limited literature suggests that the yield of repeat MRI to detect a secondary lesion varies between 0 to 16% of patients with spontaneous ICH, with secondary lesions typically found to be tumors or cavernomas ( Mouchtouris et al, 2021 ; Wilson et al, 2023 ). Studies evaluating outpatient follow-up MRI in this setting have included studies performed any time from 1 day to 2 years post-ICH, and the optimal timing of this repeat imaging remains unclear (particularly given the complex evolution of blood products discussed above) ( Mouchtouris et al, 2021 ; Wilson et al, 2023 ).…”

“…Limited literature suggests that the yield of repeat MRI to detect a secondary lesion varies between 0 to 16% of patients with spontaneous ICH, with secondary lesions typically found to be tumors or cavernomas ( Mouchtouris et al, 2021 ; Wilson et al, 2023 ). Studies evaluating outpatient follow-up MRI in this setting have included studies performed any time from 1 day to 2 years post-ICH, and the optimal timing of this repeat imaging remains unclear (particularly given the complex evolution of blood products discussed above) ( Mouchtouris et al, 2021 ; Wilson et al, 2023 ). Future research is required to determine optimal timing for follow-up MRI scans, as well as to identify the specific patient cohorts who would benefit most from such assessments.…”