Study challenges use of MRI in spontaneous deep intracerebral hemorrhage
New findings are challenging the tendency of emergency providers to order brain MRI scans for acute evaluation of patients with spontaneous deep intracerebral hemorrhage (ICH).
Spontaneous ICH carries a heightened risk of mortality, making locating its origin in a timely manner critical to outcomes. Hypertensive hemorrhage is the most common type of ICH, and it typically occurs in deeper structures of the brain.
Contrast-enhanced CT imaging is typically the go-to modality for patients who present with stroke-like symptoms due to its accessibility and time efficiency. Given the sensitivity of MRI, when available, many providers may also seek to add an MRI brain scan in cases of diagnostic uncertainty.
However, new findings published in Emergency Radiology suggest that the exam may not yield additional value in cases of deep ICH.
“MRI, although slower and less accessible, can offer even greater sensitivity and specificity relative to CT for detecting ICH. In addition, MRI offers improved sensitivity relative to CT in uncovering culprit lesions in cases of unexplained ICH,” Hudson McKinney, an MD candidate at the department of radiology at Wake Forest School of Medicine, and colleagues noted. “However, MRI may often offer little added benefit to CT in cases where clinical history and CT findings point to a diagnosis of hypertensive hemorrhage.”
The team sought to better understand the yield of brain MRI scans in these patients. To do this, they retrospectively reviewed cases of deep ICH at a single tertiary care academic center over a 5-year period, excluding cases with known causes. Patients’ history and demographics, blood pressure at presentation, results of the initial noncontrast head CT and subsequent imaging studies were all incorporated into the data analyzed.
Nearly 85% of the cohort had a history of hypertension, while another 6% were screen positive for cocaine or amphetamines at the time of their presentation. Of the 222 patients included in the final analysis, 120 underwent MRI—70% of which included post-contrast imaging—around 1 day after having a CT scan. Of those, just a single scan identified a culprit lesion adjacent to a cerebellar hematoma. However, that lesion was later found to be a pilocytic astrocytoma.
“While MRI certainly has the potential to uncover culprit lesions that may be occult on CT, including vascular malformations and tumors, an underlying lesion is not expected to be identified in cases of hypertensive hemorrhage,” the authors advised. “Therefore, it is logical to expect the yield of MRI in cases of probable hypertensive hemorrhage to be lower than in other cases of spontaneous ICH.”
The group acknowledged that MRI brings added value in determining future risk and the likelihood of further complications. However, it likely is not suitable for acute scenarios involving deep ICH.
Learn more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.