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. 2022 Aug;31(8):106549.
doi: 10.1016/j.jstrokecerebrovasdis.2022.106549. Epub 2022 May 12.

Diffusion-Weighted Imaging Hyperintensities in Acute and Subacute-Phase Intracerebral Hemorrhage

Yuji Shiga  1 , Shiro Aoki  2 , Saki Tasaka  1 , Jun Takeshita  3 , Teppei Kamimura  4 , Naoyuki Hara  5 , Ryo Shimomura  1 , Hayato Matsushima  6 , Masahiro Nakamori  3 , Tomohisa Nezu  3 , Eiji Imamura  1 , Tatsuya Mizoue  7 , Shinichi Wakabayashi  7 , Hirofumi Maruyama  3
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Diffusion-Weighted Imaging Hyperintensities in Acute and Subacute-Phase Intracerebral Hemorrhage

Yuji Shiga et al. J Stroke Cerebrovasc Dis. 2022 Aug.

Abstract

Objective: Diffusion-weighted imaging hyperintensities are observed in intracerebral hemorrhage patients at times and might be associated with unfavorable functional outcomes. However, the suitable time to evaluate diffusion-weighted imaging hyperintensities to influence stroke outcome remains unclear. This study investigated the associations between acute and sub-acute diffusion-weighted imaging hyperintensities and functional outcomes among patients with acute intracerebral hemorrhage.

Methods: Diffusion-weighted imaging hyperintensities were evaluated within 24 h (acute phase) and at 14 ± 5 days (sub-acute phase). An unfavorable functional outcome was a score of 5-6 on the modified Rankin Scale at 3 months.

Results: Among 268 intracerebral hemorrhage patients, diffusion-weighted imaging hyperintensities in the acute phase were observed in 32 (11.9%). Among 227 patients who underwent a second magnetic resonance imaging in the sub-acute phase, diffusion-weighted imaging hyperintensities were observed in 57 (25.1%). Multivariable analysis revealed that the baseline intracerebral hemorrhage volume, history of stroke, and severe white matter lesions were associated with sub-acute diffusion-weighted imaging hyperintensities. The patients with unfavorable outcomes (n = 37) had a higher frequency of sub-acute diffusion-weighted imaging hyperintensities than those without (n = 190) (51.4% vs. 20.0%, P < 0.001); the frequencies of acute diffusion-weighted imaging hyperintensities were not significantly different between the groups (13.5% vs. 10.0%, P = 0.559). Sub-acute diffusion-weighted imaging hyperintensities were independently associated with unfavorable outcomes after adjusting for confounding factors (Odds Ratio, 3.35, 95% CI 1.20-9.35, P = 0.021).

Conclusion: The rate of sub-acute diffusion-weighted imaging hyperintensities was higher than acute diffusion-weighted imaging hyperintensities among acute intracerebral hemorrhage patients and likely to be associated with unfavorable outcomes.

Keywords: Diffusion-weighted imaging; Intracerebral hemorrhage; Outcome; Subacute phase.

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Conflict of interest statement

Declaration of Competing Interest Dr. Maruyama received Grants-in-Aid for Scientific Research (20K07887) and research support from Eisai, Pfizer, Takeda Pharmaceutical, Otsuka Pharmaceutical, Nihon Pharmaceutical, Shionogi, Teijin Pharma, Fuji Film, Sumitomo Dainippon Pharma, Nihon Medi-Physics, Bayer, MSD, Daiichi Sankyo, Kyowa Hakko Kirin, Sanofi, Novartis, Kowa Pharmaceutical, Astellas Pharma, Tsumura, and Japan Blood Products Organization, which are unrelated to the submitted work. All other authors declare that they have no conflicts of interest. Role of Funding Sources.

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