MRI Markers of Small Vessel Disease in Lobar and Deep Hemispheric Intracerebral Hemorrhage
Open accessAbstract
Background and Purpose— MRI evidence of small vessel disease is common in intracerebral hemorrhage (ICH). We hypothesized that ICH caused by cerebral amyloid angiopathy (CAA) or hypertensive vasculopathy would have different distributions of MRI T2 white matter hyperintensity (WMH) and microbleeds. Methods— Data were analyzed from 133 consecutive patients with primary supratentorial ICH and adequate MRI sequences. CAA was diagnosed using the Boston criteria. WMH segmentation was performed using a validated semiautomated method. WMH and microbleeds were compared according to site of symptomatic hematoma origin (lobar versus deep) or by pattern of hemorrhages, including both hematomas and microbleeds, on MRI gradient recalled echo sequence (grouped as lobar only–probable CAA, lobar only–possible CAA, deep hemispheric only, or mixed lobar and deep hemorrhages). Results— Patients with lobar and deep hemispheric hematoma had similar median normalized WMH volumes (19.5 cm versus 19.9 cm 3 , P =0.74) and prevalence of ≥1 microbleed (54% versus 52%, P =0.99). The supratentorial WMH distribution was similar according to hemorrhage location category; however, the prevalence of brain stem T2 hyperintensity was lower in lobar hematoma versus deep hematoma (54% versus 70%, P =0.004). Mixed ICH was common (23%). Patients with mixed ICH had large normalized WMH volumes and a posterior distribution of cortical hemorrhages similar to that seen in CAA. Conclusions— WMH distribution is largely similar between CAA-related and non-CAA-related ICH. Mixed lobar and deep hemorrhages are seen on MRI gradient recalled echo sequence in up to one fourth of patients; in these patients, both hypertension and CAA may be contributing to the burden of WMH.
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A recent study found an association between coincident hypertension and larger volumes of white matter lesions in patients with cerebral amyloid angiopathy.
“A recent study found an association between coincident hypertension and larger volumes of WMLs in patients with CAA,159”
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- Authors
- Smith, E. E., Nandigam, K. R. N., Chen, Y.-W., Jeng, J., Salat, D., Halpin, A., Frosch, M., Wendell, L., Fazen, L., Rosand, J., Viswanathan, A., & Greenberg, S. M.
- Affiliations
- National Taiwan University (TW)
- ORCID
- Venue
- Stroke
- Published
- 2010-09
- Volume
- 41
- Issue
- 9
- Pages
- 1933-1938
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC4084787
- OpenAlex
- W2161079228
- Cited by
- 95
- References
- 24
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 7 · 2018: 9 · 2017: 4 · 2016: 7 · 2015: 9 · 2014: 8 · 2013: 10 · 2012: 6
- FWCI
- 5.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG026484)
- National Institute of Neurological Disorders and Stroke (K23NS046327, K24NS056207)
- Topics
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Keywords
- intracerebral hemorrhage, cerebral small vessel disease, cerebral amyloid angiopathy, hypertensive vasculopathy, white matter hyperintensities, microbleeds, lobar hemorrhage, MRI markers
- MeSH terms
- Aged, Aged, 80 and over, Brain, Brain Mapping, Cerebrovascular Disorders, Diagnosis, Differential, Female, Humans, Hypertension, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Cerebral Amyloid Angiopathy
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