Association of Renal Dysfunction With Remote Diffusion-Weighted Imaging Lesions and Total Burden of Cerebral Small Vessel Disease in Patients With Primary Intracerebral Hemorrhage

Abstract

Objective: Remote diffusion-weighted imaging (DWI) lesions (R-DWIL) found in intracerebral hemorrhage (ICH) patients are considered as an additional marker of cerebral small vessel disease (cSVD). This study aimed to investigate the association of renal dysfunction and R-DWIL, as well as the total burden of cSVD on magnetic resonance imaging among patients with primary ICH. Methods: One hundred and twenty-six consecutive patients were prospectively enrolled. R-DWIL on DWI, as well as other imaging markers of cSVD, including lacunes, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces were rated using validated scales. Renal dysfunction was evaluated either by reduced estimated glomerular filtration rate (eGFR) or the presence of proteinuria or increased cystatin C. Results: After adjustments for potential confounders by logistic regression, impaired eGFR [odds ratio (OR) 6.00, 95% confidence interval (CI) 1.73-20.78], proteinuria (OR 3.07, 95% CI 1.25-7.54) and increased cystatin C (OR 2.73, 95% CI 1.11-6.72) were correlated with presence of R-DWIL. A similar association was also found between cystatin C levels (OR 3.16, 95% CI 1.39-7.19), proteinuria (OR 2.79, 95% CI 1.34-5.83) and the comprehensive cSVD burden. Conclusions: Renal dysfunction are associated with the presence of R-DWIL, and total burden of cSVD in patients with primary ICH.

Keywords: cerebral small vessel disease; cystatin C; glomerular filtration rate; proteinuria; remote DWI lesions; renal dysfunction.

Figure 1

In a 75-year-old female with left basal ganglia hemorrhage (A), diffusion weighted imaging (DWI) shows a small remote ischemic lesion on right frontal angle (B), with corresponding low signal intensity in apparent diffusion coefficient (ADC) map (C).

Figure 2

In an 80-year-old man with left occipital hematoma, MRI shows all 4 markers involved in total cSVD burden. (A) SWAN shows CMBs in left basal ganglia. (B) FLAIR image shows PWMH in bilateral side. (C) T2-sequence shows EPVS in bilateral basal ganglia. (D) FLAIR image shows lacune in right para-lateral ventricle. No R-DWIL was found on MRI (not shown). eGFR in this patient was 85.2 mL/min/1.73 m², proteinuria was 2+, and cystatin C was 2.07 mg/L. CMBs, cerebral microbleeds; EPVS, enlarged perivascular spaces; FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging; SWAN, star weighted angiography; PWMH, periventricular white matter hyperintensity; R-DWIL, remote DWI lesions; eGFR, estimated glomerular filtration rate.

Figure 3

Pearson's correlation analysis between cystatin C and eGFR or proteinuria (Cystatin C and eGFR, r = −0.80, p = 0.000; Cystatin C and proteinuria, r = 0.218, p = 0.015). ° Indicates data from patients; eGFR, estimated glomerular filtration rate.