Yonsei Med J.  2019 Aug;60(8):774-781. 10.3349/ymj.2019.60.8.774.

MRI Assessment of Cerebral Small Vessel Disease in Patients with Spontaneous Intracerebral Hemorrhage

• Park YS
• Chung MS
• Choi BS

• KMID: 2452959
• DOI: http://doi.org/10.3349/ymj.2019.60.8.774

Abstract

PURPOSE
Cerebral small vessel disease (SVD) is known to be associated with ischemic stroke, intracerebral hemorrhage (ICH), and cognitive impairment. In this retrospective observational study, we explored SVD markers on MRI relevant to spontaneous ICH.
MATERIALS AND METHODS
The ICH group consisted of 150 consecutive patients with a first primary parenchymal ICH, and the control group consisted of 271 age- and sex-matched individuals who underwent brain MRI in a health care center. We compared cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular space (EPVS), and lacunae in the ICH and control groups.
RESULTS
A total of 1278 CMB lesions were identified in 121 of the 150 patients in the ICH group (80.6%), while 77 CMB lesions were found in 32 of the 271 individuals in the control group (11.8%). WMH and EPVS were more severe and lacunae were more frequent in the ICH patients than in the control group. When receiver operating characteristic (ROC) curves were plotted, number of CMBs most significantly predicted ICH. All imaging markers were significantly associated with ICH in every age group. The location of CMBs coincided with the location of ICH, and ICH volume correlated with CMB count.
CONCLUSION
All MRI markers for SVD were worse in ICH patients than in healthy controls, and these markers were prominent even in young ICH patients. Lacunae, WMH, EPVS, and CMB should be considered as factors related with spontaneous ICH.

Keyword

Cerebral amyloid angiopathy; cerebral small vessel disease; hypertension; intracranial hemorrhage

MeSH Terms

Brain
Cerebral Amyloid Angiopathy
Cerebral Hemorrhage*
Cerebral Small Vessel Diseases*
Cognition Disorders
Delivery of Health Care
Humans
Hypertension
Intracranial Hemorrhages
Magnetic Resonance Imaging*
Observational Study
Retrospective Studies
ROC Curve
Stroke
White Matter

Figure

• 

  Fig. 1 Area under the receiver operating characteristic (ROC) curves were plotted with the number of cerebral microbleeds (CMB), the number of lacunae, periventricular (PVWMH) and deep white matter hyperintensity (DWWMH), and basal ganglia (BGEPVS) and centrum semiovale enlarged perivascular space (CSEPVS). The number of CMBs most significantly predicts intracerebral hemorrhage. No. of CMB, number of CMB; No. of lacune, number of lacunae.

• 

  Fig. 2 The distribution of small vessel disease imaging markers by age group. Cerebral microbleeds (CMB) (A), lacunae (B), white matter hyperintensity (WMH) (C and D), and enlarged perivascular space (EPVS) (E and F) in the intracerebral hemorrhage (ICH) group and the control group. In all age groups, CMB, lacunae, WMH, and EPVS were more severe in the ICH group than in the control group. CMBs were prominent starting in the 30s and remained consistently high with aging in the ICH group. WMH in the periventricular area and deep white matter, EPVS in the basal ganglia and centrum semiovale, and lacunae all increased gradually with aging in both groups. These MRI markers had a consistently worse grade in the ICH group, even in young patients.

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