title: MRI markers of small vessel disease in lobar and deep hemispheric intracerebral hemorrhage.
abstract: 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.
authors.affiliation: Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada. eesmith@ucalgary.org
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.forename: Kaveer R N
authors.initials: KR
authors.lastname: Nandigam
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Chen
authors.forename: Jed
authors.initials: J
authors.lastname: Jeng
authors.forename: David
authors.initials: D
authors.lastname: Salat
authors.forename: Amy
authors.initials: A
authors.lastname: Halpin
authors.forename: Matthew
authors.initials: M
authors.lastname: Frosch
authors.forename: Lauren
authors.initials: L
authors.lastname: Wendell
authors.forename: Louis
authors.initials: L
authors.lastname: Fazen
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
mesh_terms: 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