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Review
. 2021 Mar 5;10(5):1086.
doi: 10.3390/jcm10051086.

Neuroimaging of Acute Intracerebral Hemorrhage

Peter B Sporns  1   2 , Marios-Nikos Psychogios  1 , Grégoire Boulouis  3 , Andreas Charidimou  4   5 , Qi Li  6 , Enrico Fainardi  7 , Dar Dowlatshahi  8 , Joshua N Goldstein  9 , Andrea Morotti  10
Affiliations
Review

Neuroimaging of Acute Intracerebral Hemorrhage

Peter B Sporns et al. J Clin Med. .

Abstract

Intracerebral hemorrhage (ICH) accounts for 10% to 20% of all strokes worldwide and is associated with high morbidity and mortality. Neuroimaging is clinically important for the rapid diagnosis of ICH and underlying etiologies, but also for identification of ICH expansion, often as-sociated with an increased risk for poor outcome. In this context, rapid assessment of early hema-toma expansion risk is both an opportunity for therapeutic intervention and a potential hazard for hematoma evacuation surgery. In this review, we provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of neurological outcome. Specifically, we discuss standard imaging using computed tomography, the value of different vascular imaging modalities to identify underlying causes and present recent advances in magnetic resonance imaging and computed tomography perfusion.

Keywords: ICH expansion; NCCT markers; imaging; intracerebral hemorrhage; outcome; spot sign.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Example of CT Perfusion in a patient with ICH due to malignancy. Non-contrast CT (NCCT) scan (A) and cerebral blood volume (CBV) map (B) in a patient with acute ICH due to the bleeding of an underlying high grade glioma located left frontal lobe and characterized by elevated CBV values in the perihematomal region (arrows).
Figure 2
Figure 2
(A,B): Example of NCCT markers of ICH expansion. (A) Baseline NCCT with evidence of deep ICH and intrahematoma hypodensity (arrow), (B) Follow-up NCCT showing hematoma enlargement. (C–E) illustrate spot sign on T1-weighted post-contrast magnetic resonance imaging (MRI, C) within the ICH shown on susceptibility weighted images (SWI, D) and Fluid Attenuated Inversion Recovery (FLAIR) Sequence (E).
Figure 2
Figure 2
(A,B): Example of NCCT markers of ICH expansion. (A) Baseline NCCT with evidence of deep ICH and intrahematoma hypodensity (arrow), (B) Follow-up NCCT showing hematoma enlargement. (C–E) illustrate spot sign on T1-weighted post-contrast magnetic resonance imaging (MRI, C) within the ICH shown on susceptibility weighted images (SWI, D) and Fluid Attenuated Inversion Recovery (FLAIR) Sequence (E).
Figure 3
Figure 3
Small vessel disease markers. (A) MRI with evidence of lobar ICH and diffuse cortical superficial siderosis (arrows). (B) MRI with evidence of lobar ICH and lobar cerebral microbleeds (arrows).
Figure 4
Figure 4
Flowchart for diagnostic work-up in patients with acute ICH.
See this image and copyright information in PMC

References

    1. Poon M.T.C., Fonville A.F., Salman R.A.S. Long-term prognosis after intracerebral haemorrhage: Systematic review and meta-analysis. J. Neurol. Neurosurg. Psychiatry. 2014;85:660–667. doi: 10.1136/jnnp-2013-306476. - DOI - PubMed
    1. Johnson C.O., Nguyen M., Roth G.A., Nichols E., Alam T., Abate D., Abd-Allah F., Abdelalim A., Abraha H.N., Abu-Rmeileh N.M., et al. Global, regional, and national burden of stroke, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:357–375. doi: 10.1016/S1474-4422(19)30034-1. - DOI - PMC - PubMed
    1. Al-Shahi Salman R., Labovitz D.L., Stapf C. Spontaneous intracerebral haemorrhage. BMJ. 2009;339:b2586. doi: 10.1136/bmj.b2586. - DOI - PubMed
    1. Pantoni L. Cerebral small vessel disease: From pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9:689–701. doi: 10.1016/S1474-4422(10)70104-6. - DOI - PubMed
    1. Rodrigues M.A., Samarasekera N., Lerpiniere C., Humphreys C., McCarron M.O., White P.M., Nicoll J.A.R., Sudlow C.L.M., Cordonnier C., Wardlaw J.M., et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: Model development and diagnostic test accuracy study. Lancet Neurol. 2018;17:232–240. doi: 10.1016/S1474-4422(18)30006-1. - DOI - PMC - PubMed

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