The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage

Rajeev K. Garg; Jawad Khan; Robert J. Dawe; James Conners; Sayona John; Shyam Prabhakaran; Mehmet Kocak; Sudeep Bhabad; Sean L. Simpson; Bichun Ouyang; Miral Jhaveri; Thomas P. Bleck

doi:10.1007/s12028-020-00933-3

The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage

Rajeev K. Garg^*, Jawad Khan, Robert J. Dawe, James Conners, Sayona John, Shyam Prabhakaran, Mehmet Kocak, Sudeep Bhabad, Sean L. Simpson, Bichun Ouyang, Miral Jhaveri, Thomas P. Bleck

^*Corresponding author for this work

Neurology

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

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 ' 0.05) associated with worse functional outcomes defined as an mRS of 4–6. The generalized estimating equation (GEE) approach was used to investigate the effect of DWI lesions on dichotomized mRS (0–3 vs 4–6) longitudinally. Results: DWI lesions were found in 60 of 121 patients (49.6%). The presence of a DWI lesion was associated with increased odds for an mRS of 4–6 at 3 months (OR 5.987, 95% CI 1.409–25.435, p = 0.015) in logistic regression. Using the GEE model, patients with a DWI lesion were less likely to recover over time between 14 days/discharge and 3 months (p = 0.005). Conclusions: DWI lesions are common in primary sICH, occurring in almost half of our cohort. Our data suggest that DWI lesions are associated with worse mRS at 3 months in good grade sICH and are predictive of impaired recovery after hospital discharge. Further research into the pathophysiologic mechanisms underlying DWI lesions may lead to novel treatment options that may improve outcomes associated with this devastating disease.

Original language	English (US)
Pages (from-to)	552-564
Number of pages	13
Journal	Neurocritical Care
Volume	33
Issue number	2
DOIs	https://doi.org/10.1007/s12028-020-00933-3
State	Published - Oct 1 2020

Funding

Project primarily supported by the American Heart Association Midwest Affiliate Grant 11CRP7520073 (RKG), and Rush University\u2019s Department of Neurological Sciences (RKG). Additional support provided by NIBIB K25 EB012236 (SLS), R01EB024559 (SLS), and Wake Forest CTSI NCATS UL1TR001420 (SLS).

Keywords

Blood pressure
Cerebral hemorrhage
Cerebral infarction
Diffusion magnetic resonance imaging
Outcome assessment

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine
Clinical Neurology

Access to Document

10.1007/s12028-020-00933-3

Cite this

@article{05c50ca41460490a9e956c992b441e7f,

title = "The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage",

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{\textquoteright} hospital course. Blinded mRS outcomes were obtained at 3 months. Logistic regression was used to determine significant factors (p ' 0.05) associated with worse functional outcomes defined as an mRS of 4–6. The generalized estimating equation (GEE) approach was used to investigate the effect of DWI lesions on dichotomized mRS (0–3 vs 4–6) longitudinally. Results: DWI lesions were found in 60 of 121 patients (49.6%). The presence of a DWI lesion was associated with increased odds for an mRS of 4–6 at 3 months (OR 5.987, 95% CI 1.409–25.435, p = 0.015) in logistic regression. Using the GEE model, patients with a DWI lesion were less likely to recover over time between 14 days/discharge and 3 months (p = 0.005). Conclusions: DWI lesions are common in primary sICH, occurring in almost half of our cohort. Our data suggest that DWI lesions are associated with worse mRS at 3 months in good grade sICH and are predictive of impaired recovery after hospital discharge. Further research into the pathophysiologic mechanisms underlying DWI lesions may lead to novel treatment options that may improve outcomes associated with this devastating disease.",

keywords = "Blood pressure, Cerebral hemorrhage, Cerebral infarction, Diffusion magnetic resonance imaging, Outcome assessment",

author = "Garg, {Rajeev K.} and Jawad Khan and Dawe, {Robert J.} and James Conners and Sayona John and Shyam Prabhakaran and Mehmet Kocak and Sudeep Bhabad and Simpson, {Sean L.} and Bichun Ouyang and Miral Jhaveri and Bleck, {Thomas P.}",

note = "Publisher Copyright: {\textcopyright} 2020, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.",

year = "2020",

month = oct,

day = "1",

doi = "10.1007/s12028-020-00933-3",

language = "English (US)",

volume = "33",

pages = "552--564",

journal = "Neurocritical Care",

issn = "1541-6933",

publisher = "Humana Press",

number = "2",

}

TY - JOUR

T1 - The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage

AU - Garg, Rajeev K.

AU - Khan, Jawad

AU - Dawe, Robert J.

AU - Conners, James

AU - John, Sayona

AU - Prabhakaran, Shyam

AU - Kocak, Mehmet

AU - Bhabad, Sudeep

AU - Simpson, Sean L.

AU - Ouyang, Bichun

AU - Jhaveri, Miral

AU - Bleck, Thomas P.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - 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 ' 0.05) associated with worse functional outcomes defined as an mRS of 4–6. The generalized estimating equation (GEE) approach was used to investigate the effect of DWI lesions on dichotomized mRS (0–3 vs 4–6) longitudinally. Results: DWI lesions were found in 60 of 121 patients (49.6%). The presence of a DWI lesion was associated with increased odds for an mRS of 4–6 at 3 months (OR 5.987, 95% CI 1.409–25.435, p = 0.015) in logistic regression. Using the GEE model, patients with a DWI lesion were less likely to recover over time between 14 days/discharge and 3 months (p = 0.005). Conclusions: DWI lesions are common in primary sICH, occurring in almost half of our cohort. Our data suggest that DWI lesions are associated with worse mRS at 3 months in good grade sICH and are predictive of impaired recovery after hospital discharge. Further research into the pathophysiologic mechanisms underlying DWI lesions may lead to novel treatment options that may improve outcomes associated with this devastating disease.

AB - 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 ' 0.05) associated with worse functional outcomes defined as an mRS of 4–6. The generalized estimating equation (GEE) approach was used to investigate the effect of DWI lesions on dichotomized mRS (0–3 vs 4–6) longitudinally. Results: DWI lesions were found in 60 of 121 patients (49.6%). The presence of a DWI lesion was associated with increased odds for an mRS of 4–6 at 3 months (OR 5.987, 95% CI 1.409–25.435, p = 0.015) in logistic regression. Using the GEE model, patients with a DWI lesion were less likely to recover over time between 14 days/discharge and 3 months (p = 0.005). Conclusions: DWI lesions are common in primary sICH, occurring in almost half of our cohort. Our data suggest that DWI lesions are associated with worse mRS at 3 months in good grade sICH and are predictive of impaired recovery after hospital discharge. Further research into the pathophysiologic mechanisms underlying DWI lesions may lead to novel treatment options that may improve outcomes associated with this devastating disease.

KW - Blood pressure

KW - Cerebral hemorrhage

KW - Cerebral infarction

KW - Diffusion magnetic resonance imaging

KW - Outcome assessment

UR - http://www.scopus.com/inward/record.url?scp=85079695577&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85079695577&partnerID=8YFLogxK

U2 - 10.1007/s12028-020-00933-3

DO - 10.1007/s12028-020-00933-3

M3 - Article

C2 - 32072457

AN - SCOPUS:85079695577

SN - 1541-6933

VL - 33

SP - 552

EP - 564

JO - Neurocritical Care

JF - Neurocritical Care

IS - 2

ER -

The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this