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Neurocritical Care
Published in: Neurocritical Care 2/2020

01-10-2020 | Magnetic Resonance Imaging | Original Work

The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage

Authors: Rajeev K. Garg, Jawad Khan, Robert J. Dawe, James Conners, Sayona John, Shyam Prabhakaran, Mehmet Kocak, Sudeep Bhabad, Sean L. Simpson, Bichun Ouyang, Miral Jhaveri, Thomas P. Bleck

Published in: Neurocritical Care | Issue 2/2020

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Abstract

Background/Objective

Diffusion weighted imaging (DWI) lesions have been well described in patients with acute spontaneous intracerebral hemorrhage (sICH). However, there are limited data on the influence of these lesions on sICH functional outcomes. We conducted a prospective observational cohort study with blinded imaging and outcomes assessment to determine the influence of DWI lesions on long-term outcomes in patients with acute sICH. We hypothesized that DWI lesions are associated with worse modified Rankin Scale (mRS) at 3 months after hospital discharge.

Methods

Consecutive sICH patients meeting study criteria were consented for an magnetic resonance imaging (MRI) scan of the brain and evaluated for remote DWI lesions by neuroradiologists blinded to the patients’ hospital course. Blinded mRS outcomes were obtained at 3 months. Logistic regression was used to determine significant factors (p < 0.05) associated with worse functional outcomes defined as an mRS of 4–6. The generalized estimating equation (GEE) approach was used to investigate the effect of DWI lesions on dichotomized mRS (0–3 vs 4–6) longitudinally.

Results

DWI lesions were found in 60 of 121 patients (49.6%). The presence of a DWI lesion was associated with increased odds for an mRS of 4–6 at 3 months (OR 5.987, 95% CI 1.409–25.435, p = 0.015) in logistic regression. Using the GEE model, patients with a DWI lesion were less likely to recover over time between 14 days/discharge and 3 months (p = 0.005).

Conclusions

DWI lesions are common in primary sICH, occurring in almost half of our cohort. Our data suggest that DWI lesions are associated with worse mRS at 3 months in good grade sICH and are predictive of impaired recovery after hospital discharge. Further research into the pathophysiologic mechanisms underlying DWI lesions may lead to novel treatment options that may improve outcomes associated with this devastating disease.
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Metadata
Title
The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage
Authors
Rajeev K. Garg
Jawad Khan
Robert J. Dawe
James Conners
Sayona John
Shyam Prabhakaran
Mehmet Kocak
Sudeep Bhabad
Sean L. Simpson
Bichun Ouyang
Miral Jhaveri
Thomas P. Bleck
Publication date
01-10-2020
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2020
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-020-00933-3

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