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

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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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Funding

Project primarily supported by the American Heart Association Midwest Affiliate Grant 11CRP7520073 (RKG), and Rush University’s Department of Neurological Sciences (RKG). Additional support provided by NIBIB K25 EB012236 (SLS), R01EB024559 (SLS), and Wake Forest CTSI NCATS UL1TR001420 (SLS).

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Authors and Affiliations

  1. Rush University Medical Center, 1725 West Harrison Street, Suite 1106, Chicago, IL, 60612, USA

    Rajeev K. Garg, Jawad Khan, Robert J. Dawe, James Conners, Sayona John, Mehmet Kocak, Sudeep Bhabad, Bichun Ouyang, Miral Jhaveri & Thomas P. Bleck

  2. Wake Forest School of Medicine, Winston-Salem, NC, USA

    Sean L. Simpson

  3. University of Chicago, Chicago, IL, USA

    Shyam Prabhakaran

Authors
  1. Rajeev K. Garg
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  2. Jawad Khan
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Contributions

RKG, Primary Author Designed study; coordinated research study; collected and analyzed data; drafted manuscript. JK, Major role in the acquisition of blood pressure data; data interpretation. RJD, Major role in design of MRI protocol; data interpretation; revised the manuscript for intellectual content. JC, Interpreted the data; revised the manuscript for intellectual content. SJ, Interpreted the data; revised the manuscript for intellectual content. SP, Assisted with study design; interpreted the data; revised the manuscript for intellectual content. MK, Adjudication of MRI data; interpreted the data; revised the manuscript for intellectual content. SB, MRI blinded reviewer; Interpreted the data; revised the manuscript for intellectual content. SLS, Assisted with polynomial statistical analysis; performed biostatistical review of the results; BO, Major role in the statistical analysis of the results; interpreted the data; revised the manuscript for intellectual content. MJ, Major role MRI protocol design. MRI blinded reviewer; interpreted the data; revised the manuscript for intellectual content. TPB, Senior Author Reviewed all MR imaging for safety concerns; provided oversight of study protocol; Interpreted the data; revised the manuscript for intellectual content.

Corresponding author

Correspondence to Rajeev K. Garg.

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All authors have nothing to disclose.

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This study was approved by the Rush University Medical Center (RUMC) Institutional Review Board and ethics standards committee. Written informed consent was obtained from all competent participants or surrogate health care decision makers in the study.

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All work for this study was performed at Rush University Medical Center, Chicago, IL.

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Garg, R.K., Khan, J., Dawe, R.J. et al. The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage. Neurocrit Care 33, 552–564 (2020). https://doi.org/10.1007/s12028-020-00933-3

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