Low diagnostic yield in follow-up MR imaging in patients with spontaneous intracerebral hemorrhage with a negative initi
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DIAGNOSTIC NEURORADIOLOGY
Low diagnostic yield in follow-up MR imaging in patients with spontaneous intracerebral hemorrhage with a negative initial MRI Nikolaos Mouchtouris 1 & Fadi Al Saiegh 1 & Nohra Chalouhi 1 & Ahmad Sweid 1 & Emily J. Papai 2 & Daniella Wong 2 & Julie Kim 2 & Austin Saline 2 & David Nauheim 2 & Reid Gooch 1 & Stavropoula Tjoumakaris 1 & Robert Rosenwasser 1 & Pascal Jabbour 1,3 Received: 2 July 2020 / Accepted: 23 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Follow-up MRI/MRA is historically obtained as outpatient when patients with a spontaneous intracerebral hemorrhage (ICH) have an initial MRI/MRA that is negative for an underlying structural lesion. However, the utility of repeating MR imaging in a delayed fashion remains uncertain. Methods We retrospectively reviewed 396 patients with spontaneous ICH admitted at our institution between 2015 and 2017 and selected those whose initial MRI/MRA was negative for an underlying structural lesion and those who underwent follow-up MR imaging in a delayed fashion. Results A total of 113 patients met the study criteria. The average age of those with negative follow-up MRI/MRA was 65.0 ± 12.6 (IQR: 55.0–74.0) years old. None of the 113 patients with a negative inpatient MRI/MRA had an underlying structural lesion on follow-up MRI/MRA (0%, 95% CI 0.0–0.032, p < 0.001). The mean time of the follow-up imaging from the initial study was 105.7 days (median: 62 days; IQR: 42.5–100.5). Of the 113, 83 (73.5%) underwent follow-up MRI with and without gadolinium, while 30 (26.5%) patients did not receive gadolinium. Conclusion Delayed follow-up MRI in patients with a negative initial MRI/MRA for workup of spontaneous ICH was not diagnostic in any of the patients included in the study. Our study suggests that a routine follow-up MRI for this patient population is not necessary. Keywords Intracerebral hemorrhage . MRI . MR angiography . Diagnostic cerebral angiography
Introduction Non-contrast computed tomography (NCCT) has been the main imaging modality utilized in the diagnosis and followup of patients with intracerebral hemorrhages (ICH) [1, 2]. However, given its limitation in diagnosing the underlying
* Pascal Jabbour [email protected] 1
Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
2
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
3
Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA 19107, USA
etiology of the hemorrhage, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) have been added to the diagnostic algorithm to determine whether there is an underlying neoplastic, vascular, or infectious lesion [3, 4]. If the MRI/MRA is negative for a lesion, then etiologies such as hypertension or cerebral amyloid angiopathy are thought to be likely depending on the location and
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