The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrh
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ORIGINAL WORK
The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage Rajeev K. Garg1* , Jawad Khan1, Robert J. Dawe1, James Conners1, Sayona John1, Shyam Prabhakaran3, Mehmet Kocak1, Sudeep Bhabad1, Sean L. Simpson2, Bichun Ouyang1, Miral Jhaveri1 and Thomas P. Bleck1 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
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 18 years and 2, (6) Glasgow Coma Scale (GCS) 3.
Results During the study period, 705 patients were admitted with a diagnosis of a primary sICH and could safely obtain an MRI. Thirty-six patients had withdrawal of life support and were excluded. An additional 9 patients were excluded due to a competing sICH intervention trial. Therefore, 660 patients were screened for enrollment during the study period (Supplemental Figure 1).
From this cohort, 231 patients (35%) met the study’s predefined criteria, of which 139 (60.2%) provided consent. 121 were able to complete the MRI protocol. The remaining 18 were unable to tolerate the MRI due to hyperactive delirium or claustrophobia. A comparison of participants who completed an MRI versus non-consented subjects shows the groups were statistically significantly different for race (p = 0.0006) and total ICH score (p = 0.01) (Supplemental Table 1). Table 1 shows the overall characteristics of the consented study cohort. The mean age was 56.5 ± 10.9 years; 59.5% (n = 72) were men, and 54.6% (n = 66) were African-American. A majority of subjects (n = 113, 93.4%) were diagnosed with hypertensive sICH. The mean ICH volume on admission was 9.3 mL (± 13.3), and the median ICH score was 1 (IQR 1). Most patients (81%) had a supratentorial hematoma. EVD were placed in 19 patients. Median time to MRI from admission for the cohort was 75.9 h (IQR 77.9). Interrater reliability for the presence of DWI between MRI readers yielded a kappa = 0.78 (95% CI 0.68, 0.89) indicating substantial agreement [27]. Among the overall cohort, 49.6% of patients with primary sICH had one or more DWI lesions (Fig. 1). The range of DWI lesions was between 1 an
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