Abstract
Objective: The exact relationship between white matter hyperintensity (WMH) and intracerebral hemorrhage (ICH) after ICH remains unclear. In this retrospective study, we investigated whether patients with ICH had more severe WMH progression.Patients and Methods: A total of 2,951 patients aged ≥40 years with ICH who received brain computed tomography (CT) imaging within 12 h of ICH symptom onset were screened. Ninety patients with two fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) assessments, including 36 patients with Lobar ICH, 40 with basal ganglia region ICH and 14 with ICH at other sites, were included in the final study. We selected 90 age- and gender-matched healthy individuals with two MRI scans as the control group. The WMH volumes at baseline and follow-up were assessed using the FLAIR image by MRICRON and ITK-SNAP software, while the hematoma volumes were calculated based on the CT images using ITK-SNAP software.Results: The annual progression rate of WMH was significantly higher in the ICH group compared with the control group (p < 0.05). Furthermore, WMH progression was associated with the ICH volume. The largest ICH volume (>30 mL) was associated with the highest annual progression rate of WMH (p < 0.05). In contrast, no trend toward an association between ICH location and the annual progression rate of WMH was observed (p > 0.05).Conclusions: Our results showed that ICH patients had more severe WMH progression and that larger ICH volume was related to greater progression of WMH after ICH. These results could provide important prognostic information about patients with ICH.
Highlights
Intracerebral hemorrhage (ICH) accounts for approximately 10%–15% of all strokes in Western countries and 20%–30% of strokes in Asia and has a high mortality and poor functional outcome (Wen et al, 2018)
The volume of WM hyperintensity (WMH) increased by 20% annually in the control group; the annual progression rate of ICH patients increased by 33%, which was significantly higher than that of control patients (ICH vs. control: 0.33 ± 0.41 vs. 0.20 ± 0.32, p = 0.01)
The univariate linear regression analysis showed that ICH, hypertension history, transient ischemic attack (TIA) or stroke history, systolic blood pressures (SBPs) and diastolic blood pressures (DBPs) were risk factors for the annual progression rate of WMH
Summary
Intracerebral hemorrhage (ICH) accounts for approximately 10%–15% of all strokes in Western countries and 20%–30% of strokes in Asia and has a high mortality and poor functional outcome (Wen et al, 2018). ICH causes gray matter (GM) destruction as well as proximal or distal white matter injury (WMI) due to complex pathophysiological mechanisms. WM hyperintensity (WMH) is a neuroimaging finding of WMI characterized by bilateral, mostly symmetrical, hyperintensities on T2-weighted magnetic resonance imaging (MRI; Wardlaw et al, 2013). 70% of people over 65 years of age with ICH present with varying degrees of WMH on MRI (de Leeuw et al, 2001; Smith et al, 2017). More attention should be paid to the progression of WMH after ICH
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