Longitudinal, Quantitative, Multimodal MRI Evaluation of Patients With Intracerebral Hemorrhage Over the First Year

Abstract

In most patients with intracerebral hemorrhage (ICH), the hematoma and perihematomal area decrease over the subsequent months but patients continue to exhibit neurological impairments. In this serial imaging study, we characterized microstructural and neurophysiological changes in the ICH-affected brain tissues and collected the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Score (mRS), two clinical stroke scale scores. Twelve ICH patients were serially imaged on a 3T MRI at 1, 3, and 12 months (M) after injury. The hematoma and perihematomal volume masks were created and segmented using FLAIR imaging at 1 month which were applied to compute the susceptibilities (χ), fractional anisotropy (FA), mean diffusivity (MD), and cerebral blood flow (CBF) in the same tissues over time and in the matching contralesional tissues. At 3 M, there was a significant (p < 0.001) reduction in hematoma and perihematomal volumes. At 1 M, the χ, FA, and CBF were decreased in the perihematomal tissues as compared to the contralateral side, whereas MD increased. In the hematomal tissues, the χ increased whereas FA, MD, and CBF decreased as compared to the contralesional area at 1 M. Temporally, CBF in the hematoma and perihematomal tissues remained significantly (p < 0.05) lower compared with the contralesional areas whereas MD in the hematoma and χ in the perihematomal area increased. The NIHSS and mRS significantly correlated with hematoma and perihematomal volume but not with microstructural integrity. Our serial imaging studies provide new information on the long-term changes within the brain after ICH and our findings may have clinical significance that warrants future studies.

Dynamic Imaging of Blood Coagulation Within the Hematoma of Patients With Acute Hemorrhagic Stroke

“…We suspect the difference was due to a faster rate of coagulation or hematoma age. In previous longitudinal imaging studies of patients with chronic ICH, we did not observe a significant increase in hematoma susceptibility between 1 and 12 months but rather a significant decrease between 3 and 12 months of ictus, 36 which is in line with cross-sectional studies by Chang et al and Champagne et al, who also reported a decrease in hematoma susceptibilities in the later stages of hematoma.…”

Advances in differential diagnosis of cerebrovascular diseases in magnetic resonance imaging: a narrative review

“…In the hematomal tissues, the susceptibilities increase; however, fractional anisotropy, mean diffusivity and cerebral blood flow decrease relative to the contralesional area. At 3 months, hematoma and perihematomal volumes reduce significantly (70).…”