MRI markers of small vessel disease in lobar and deep hemispheric intracerebral hemorrhage.
OBJECTIVE
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 >or=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.
Smith
Eric E
EE
Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada. eesmith@ucalgary.org
Nandigam
Kaveer R N
KR
Chen
Yu-Wei
YW
Jeng
Jed
J
Salat
David
D
Halpin
Amy
A
Frosch
Matthew
M
Wendell
Lauren
L
Fazen
Louis
L
Rosand
Jonathan
J
Viswanathan
Anand
A
Greenberg
Steven M
SM
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D001931:Brain Mapping; D016657:Cerebral Amyloid Angiopathy / Q000473:pathology* / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged