Abstract T P312: Utility of Early MRI in Intracerebral Hemorrhage
Introduction: Intracerebral hemorrhage (ICH) causes significant morbidity and mortality. Utility of early magnetic resonance imaging (MRI) is not fully understood. Identifying patients in whom early MRI changes clinical management may improve outcomes in select patients and reduce costs overall by avoiding inpatient MRIs in patients who are unlikely to benefit.
Hypothesis: We assessed the hypothesis that early MRI in patients with spontaneous ICH does not alter management acutely in older patients.
Methods: We conducted a retrospective chart review of all ICH admitted to our institution from 2006-2012. Patients were excluded if they 1) had a known underlying lesion, 2) were < 18 years, 3) suffered ICH as a result of trauma or 4) did not undergo MRI. Data were evaluated for clinical or radiographic characteristics that resulted in a change in clinical management, including surgical intervention or future avoidance of antithrombotic medications, among others.
Results: In total, 248 patients with a median age of 70 years (IQR 58-78) were included. MRI changed management in 79 patients (31.9%). Initial MRI was obtained an average of 10 days after the hemorrhage. Possible structural abnormalities requiring emergent intervention were found in 14 (17.7%) patients, while 64 (81.0%) had findings concerning for other non-emergent/non-surgical anomalies (possible tumor (n=6), cavernoma (n=7), alternate diagnosis (n=1), probable amyloid angiopathy (n=21), evaluation for embolic phenomenon (n=13), evaluation for vasculitis (n=2), abnormal edema/enhancement (n=8), MRI led to additional non-invasive vascular imaging (n=6)). One patient (1.3%) was found to have a venous sinus thrombosis prompting anticoagulation. MRI was more likely to result in a change in management in patients < 55 years of age (47.1% vs 27.9%, p=0.009).
Conclusions: MRI after ICH changed management in approximately one-third of patients and resulted in an immediate change in management in a minority of patients. Younger patients are more likely to benefit from early MRI. In older patients suspected of amyloid angiopathy that may preclude future antithrombotic therapy, delayed MRI in the outpatient setting may be reasonable.
Author Disclosures: S.A. Braksick: None. S. Hocker: None.
- © 2015 by American Heart Association, Inc.