A Rule to Identify Patients Who Require Magnetic Resonance Imaging After Intracerebral Hemorrhage
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ORIGINAL ARTICLE
A Rule to Identify Patients Who Require Magnetic Resonance Imaging After Intracerebral Hemorrhage Hooman Kamel • Babak B. Navi • J. Claude Hemphill III
Published online: 15 July 2011 Ó Springer Science+Business Media, LLC 2011
Abstract Background A study performed in Hong Kong of catheter angiography after ICH found a high rate of structural lesions in patients 45 years of age or younger, without a history of hypertension, or with lobar hemorrhage. We hypothesized that a clinical decision rule based on these Hong Kong criteria would reliably identify patients who require MRI after ICH. Methods We identified all patients admitted with ICH to our medical center during a 5-year period who underwent brain MRI. Patients were excluded if the history revealed an obvious cause of ICH. Two study neurologists independently adjudicated whether MRI revealed the cause of ICH. We devised a rule recommending MRI if patients met one or more Hong Kong criteria, and calculated the proportion of patients with diagnostic MRI studies who would have been identified by this rule. We also examined the performance of a modified rule using age B 55 years. Results The original Hong Kong rule applied to 102 of the 148 patients in our cohort (69%), and would have recommended MRI in 25 of 27 patients with diagnostic MRI studies (93%, 95% CI 76–99%). The modified rule applied to 110 patients (74%), and would have recommended MRI in all 27 patients with diagnostic MRI studies (100%, 95% CI 91–100%).
H. Kamel (&) B. B. Navi Department of Neurology and Neuroscience, Weill Cornell Medical College, 525 East 68th St, F610, New York, NY 10065, USA e-mail: [email protected] J. C. Hemphill III Department of Neurology, University of California, San Francisco, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143, USA
Conclusions A rule based on simple clinical criteria may be useful for stratifying the yield of MRI after ICH. If validated in further studies, such a rule could reduce the number of unnecessary MRI studies after ICH, leading to more cost-effective care. Keywords Intracerebral hemorrhage Imaging Magnetic resonance imaging Diagnostic test assessment
Introduction Approximately 115,000 Americans each year suffer a spontaneous intracerebral hemorrhage (ICH) [1]. Of these patients, 30% die in the hospital [1], another 20% die within 1 month, and only 20% remain independent at 6 months [2]. The most common cause of this disabling disease is hypertension, and treatment of hypertension significantly reduces the risk of recurrent ICH [3]. In addition, ICH may be caused by vascular or parenchymal lesions that require different management. Common examples of such lesions include vascular malformations [4], neoplasms [5], hemorrhagic transformation of infarcts [6], and amyloid angiopathy [7]. Given its superior resolution and signal characteristics, magnetic resonance imaging (MRI) is recommended for assessing patients with ICH for such underlying lesions [8]. Several clinical series have demonstrated that MRI reveals
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