Background and Purpose: Cerebral small vessel disease (CSVD) markers have not been widely studied in relation to hematoma volume and growth in hypertensive intracerebral hemorrhage (ICH). The objectives to assess the relationship of white matter hyperintense lesions (WMHL), microbleeds (MBs), and cortical siderosis (CSS) with hematoma volume, hematoma expansion (HE), and 3 months outcome in patients with hypertensive ICH. Methods: All consecutive acute hypertensive supratentorial ICH presenting to the emergency were prospectively recruited. Baseline and 24 hours computed tomography (CT) to assess hematoma volume and magnetic resonance imaging (MRI) for CSVD markers were performed in all subjects. WMHL (graded using Fazekas's scale), MBs, and CSS were assessed and compared with baseline variables and outcomes. All the images were assessed by an experienced stroke neurologist/neuroradiologist. Results: One hundred and fifty-seven patients were screened and 60 were included. Mean age was 54.08 ± 11.57 years and 47 (78%) were males. Of 60, 19 (28.1%) had HE, 31 (51.6%) had major bleed (>30 ml), and 28 (47.46%) had poor 3 month outcome (mRS 4-6). On univariate analysis, high grade WMHL was associated with greater HE [odds ratio (OR): 2.65, confidence interval (CI) 1.48–4.72, P = 0.001), greater proportion with volume >30 ml (OR: 7.16, CI: 1.09–47.13, P = 0.001) and poor outcome (OR: 2.1, CI: 0.05–3.27, P = 0.001). MBs were associated with poor outcome (P = 0.029) but not with HE/volume. CSS was related to HE (P = 0.031), a large volume bleed (P = 0.023), and poor outcome (P = 0.021). On multivariate model, only WMHL independently predicted HE (P = 0.034), greater proportion with bleed volume >30 ml (P = 0.041), and poor outcome (P = 0.042). Conclusions: WMHL in MRI serves as a predictor of hematoma expansion, a large volume bleed, and poor outcome in hypertensive ICH and may be incorporated into existing prediction models.


中文翻译：

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脑小血管疾病的影像学标志物是否可以预测急性脑出血的血肿量和结局？



背景和目的：脑小血管病（CSVD）标志物与高血压脑出血（ICH）血肿体积和生长的关系尚未得到广泛研究。目的是评估高血压脑出血患者白质高信号病变 (WMHL)、微出血 (MB) 和皮质铁沉积 (CSS) 与血肿体积、血肿扩张 (HE) 和 3 个月结局的关系。方法：前瞻性招募所有因急诊就诊的连续急性高血压幕上脑出血。对所有受试者进行基线和 24 小时计算机断层扫描 (CT) 评估血肿体积，并进行磁共振成像 (MRI) 检测 CSVD 标志物。对 WMHL（使用 Fazekas 量表分级）、MB 和 CSS 进行评估，并与基线变量和结果进行比较。所有图像均由经验丰富的中风神经科医生/神经放射科医生进行评估。结果：筛选了 157 名患者，纳入 60 名。平均年龄为 54.08 ± 11.57 岁，其中 47 名 (78%) 为男性。在 60 例中，19 例 (28.1%) 患有 HE，31 例 (51.6%) 发生大出血 (>30 ml)，28 例 (47.46%) 3 个月结果较差 (mRS 4-6)。在单变量分析中，高级别 WMHL 与较高的 HE 相关[比值比 (OR)：2.65，置信区间 (CI) 1.48–4.72， P = 0.001），体积 >30 ml 的比例较高（OR：7.16，CI：1.09） –47.13， P = 0.001），结果较差（OR：2.1，CI：0.05–3.27， P = 0.001）。 MB 与不良结果相关（ P = 0.029），但与 HE/体积无关。 CSS 与 HE ( P = 0.031)、大量出血 (P = 0.023) 和不良预后 ( P = 0.021) 相关。在多变量模型上，只有 WMHL 独立预测 HE（ P = 0。034），出血量>30 ml（ P = 0.041）的比例更大，结果较差（P = 0.042）。结论： MRI 中的 WMHL 可作为高血压脑出血中血肿扩大、大量出血和预后不良的预测因子，并可纳入现有的预测模型中。