Predicting poor 90-day prognosis in acute spontaneous intracerebral hemorrhage patients using initial MRI signs of cerebral small vessel disease (CSVD): a retrospective cohort study

Abstract

Background

Various factors impact the prognosis of the patients with intracerebral hemorrhage (ICH).

Purpose

To evaluate the initial magnetic resonance imaging (MRI) indicators of cerebral small vessel disease (CSVD) and evaluate the relationship between the MRI indicators and ICH prognosis.

Material and Methods

Clinical and imaging data were collected from individuals diagnosed with acute ICH who had undergone MRI within 48 h of symptom onset between October 2021 and March 2022. The 90-day modified Rankin Scale (mRS) scores were analyzed, focusing on identifying those patients with a mRS score ≥3 points, which was consistent with a poor prognosis.

Results

A total of 220 ICH patients were evaluated, with 81 (36.8%) having a poor prognosis at 90 days. The study identified encephalatrophy (P = 0.014, odds ratio [OR] = 2.431, 95% confidence interval [CI] = 1.242–3.768), grade 2 periventricular Fazekas scale (P = 0.021, OR = 2.389, 95% CI = 1.174–2.869), centrum semiovale perivascular space (P = 0.035, OR = 2.296, 95% CI = 1.110–3.798), age (P = 0.002, OR = 1.046, 95% CI = 1.017–1.077), female sex (P = 0.015, OR = 0.463, 95% CI = 0.250–0.859), and admission National Institutes of Health Stroke Scale score (P = 0.003, OR = 1.052, 95% CI = 1.022–1.084) as independent risk factors for poor prognosis of an ICH. The incorporation of MRI findings significantly enhanced the predictive accuracy of the poor prognosis model in comparison to a model lacking MRI findings (AUC = 0.833 vs. 0.815, net reclassification index = 0.186; P = 0.021, integrated discrimination improvement = 0.158; P = 0.016).

Conclusion

Identification of initial MRI findings of CSVD, such as white matter hyperintensity, perivascular spaces, cerebral microbleeds, lacunar infarcts, brain atrophy, and leukodystrophy, has the potential to enhance prognostication of patients with ICHs.