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Published on: November 20, 2015
MRI Characterization of Non-traumatic Intracerebral Hemorrhage in Young Adults
Mohamed Elmegiri1, Riku-Jaakko Koivunen2, Turgut Tatlisumak3,4
1Department of Radiology, Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
Magnetic Resonance Imaging (MRI) is highly sensitive for detecting causes of non-traumatic intracerebral hemorrhage (ICH) in young adults. This diagnostic approach aids in identifying underlying structural issues for targeted secondary prevention strategies.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Non-traumatic intracerebral hemorrhage (ICH) is rare in younger individuals but carries significant mortality and poor outcomes.
- Identifying the cause of ICH is crucial for guiding treatment and prevention.
- Previous studies show a high rate of elusive causes for ICH, with limited use of MRI in diagnosis.
Purpose of the Study:
- To analyze MRI findings in young patients diagnosed with ICH.
- To assess the sensitivity and specificity of MRI in detecting structural or local causes of ICH in this demographic.
Main Methods:
- A prospective study included 116 patients aged 15-49 years with first-ever ICH from 2000-2010.
- All patients underwent MRI within three months of ICH diagnosis.
- A senior neuroradiologist analyzed imaging data, blinded to the clinical diagnosis, to determine diagnostic accuracy.
Main Results:
- Structural/local causes accounted for 50% of ICH cases in young adults, with bleeding cavernomas (23.3%) being the most common.
- MRI demonstrated high sensitivity (90.0%) for detecting structural/local causes, outperforming angiographic imaging (55.6%).
- MRI showed a specificity of 87.3% for structural/local causes, while angiographic imaging had 97.4% specificity.
Conclusions:
- MRI is a highly sensitive tool for identifying structural and local causes of ICH in young adults.
- The findings support the inclusion of MRI in the diagnostic work-up for all young ICH patients.
- Utilizing MRI can facilitate targeted secondary prevention for individuals experiencing ICH.
Abstract:
Background and Purpose: Non-traumatic intracerebral hemorrhage (ICH) in younger population is a relatively rare event but is associated with considerable mortality and poor functional outcome. Imaging plays a crucial role in determining the underlying cause and guide treatment of ICH. In up to 41% of patients in prior studies, the underlying cause remained elusive. However, the usage of MRI as part of diagnostic work-up was scanty. We aimed to analyze MRI findings of ICH in younger patients and assess specificity and sensitivity of MRI in detecting structural or local underlying causes of ICH. Methods: We included patients aged 15-49 years with first-ever ICH identified from a prospective hospital discharge registry, 2000-2010. All study patients underwent MRI within 3 months of ICH. Imaging data was analyzed by a senior neuroradiologist blinded to final clinical diagnosis. We calculated the diagnostic accuracy of MRI in detecting structural/local underlying causes. Results: Of our 116 patients (median age, 39; 67% males), structural/local causes were the leading causes of ICH (50.0%), and of these, bleeding cavernomas (23.3%) were the most frequent followed by arteriovenous malformations (12.9%), cerebral venous thrombosis (CVT) (7.8%), brain tumors (5.2%), and moyamoya disease (0.9%). Lobar location of ICH was more prevalent in younger patients. MRI was highly sensitive (90.0%; 95% confidence interval, 79.5-96.2%) for detection of structural/local causes compared with angiographic imaging (55.6%; 95% CI, 40.0-70.4%), while MRI was less specific (87.3%; 95% CI, 75.5-94.7%) for structural/local causes, compared with angiographic imaging (97.4%; 95% CI, 86.5-99.9%). Conclusion: MRI was highly sensitive for the detection of structural and local causes underlying ICH in young adults. Thus, MRI should be considered in the diagnostic work-up of all young ICH patients to enable targeted secondary prevention.
