A Pooled Analysis of Diffusion-Weighted Imaging Lesions in Patients With Acute Intracerebral Hemorrhage

Murthy, Santosh B.; Cho, Sung Min; Gupta, Ajay; Shoamanesh, Ashkan; Navi, Babak B.; Avadhani, Radhika; Gruber, Joshua; Li, Yunke; Greige, Tatiana; Lioutas, Vasileios; Norton, Casey; Zhang, Cenai; Iadecola, Costantino; Falcone, Guido J; Sheth, Kevin N; Biffi, Alessandro; Rosand, Jonathan; Qureshi, Adnan I; Goldstein, Joshua N.; Kidwell, Chelsea S.; Awad, Issam A.; Selim, Magdy; Hanley, Daniel F.; Woo, Daniel; Kamel, Hooman; Ziai, Wendy

doi:10.1001/jamaneurol.2020.2349

Cited by 47 publications

(68 citation statements)

References 32 publications

(75 reference statements)

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“…mutans . We included the presence of severe WMLs and of CMBs in the multivariable analysis because they were reported as significantly associated factors with the presence of DWI hyperintensities in the two large analyses [16,17]. In all analyses, a value of p < 0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

“…Multivariable logistic analysis was performed to identify factors associated with the presence of DWI hyperintensities, including age, sex, the presence of severe WMLs, the presence of CMBs, and the presence of cnm-positive S. mutans. We included the presence of severe WMLs and of CMBs in the multivariable analysis because they were reported as significantly associated factors with the presence of DWI hyperintensities in the two large analyses [16,17]. In all analyses, a value of p < 0.05 was considered statistically significant.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Small diffusion-weighted imaging (DWI) hyperintensities in patients with acute ICH are associated with an increased risk of both ischemic and hemorrhagic recurrent stroke, cognitive impairment, and poor outcomes [8][9][10][11][12]. The mechanism of DWI hyperintensities and what the DWI hyperintensities represent are unclear; however, acute blood pressure lowering, microangiopathy, a prothrombotic state, stress-induced hyperglycemia, enlarged perivascular spaces, and acute ischemic sequelae of chronic cerebral small vessel disease precipitated by blood pressure elevation in the setting of acute ICH have been suggested as explanations [13][14][15][16]. In addition, a meta-analysis of 11 studies revealed that the presence of DWI lesions was associated with moderate-to-severe leukoaraiosis, previous ICH, and the presence or numbers of CMBs, but not with vascular risk factors or the use of antithrombotic therapies [17].…”

Section: Introductionmentioning

confidence: 99%

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cnm‐Positive Streptococcus mutans and diffusion‐weighted imaging hyperintensities in acute intracerebral hemorrhage

Shiga

Aoki

Hosomi

et al. 2021

Euro J of Neurology

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Background Strains of Streptococcus mutans expressing the cell surface collagen‐binding protein, Cnm, encoded by cnm (cnm‐positive S. mutans), are associated with hypertensive intracerebral hemorrhage (ICH) and the occurrence of cerebral microbleeds (CMBs). Small diffusion‐weighted imaging (DWI) hyperintensities in patients with acute ICH are also associated with CMBs. However, the association between cnm‐positive S. mutans and DWI hyperintensities is unclear. Hence, this study aimed to investigate the association between cnm‐positive S. mutans and DWI hyperintensities in patients with acute ICH. Methods Patients with acute ICH were prospectively registered at three hospitals. Dental plaque specimens were collected within 4 days after admission, and cnm‐positive S. mutans was detected using the polymerase chain reaction. Magnetic resonance imaging at 14 ± 5 days after admission was used to evaluate DWI hyperintensities and CMBs. Results A total of 197 patients were enrolled in this study. cnm‐positive S. mutans was detected in 30 patients (15.2%), and DWI hyperintensities were observed in 56 patients (28.4%). Patients with cnm‐positive S. mutans had a higher frequency of DWI hyperintensities (50.0% vs 24.6%; p = 0.008) and a higher number of CMBs (5.5 vs 1.5; p < 0.001) than those without cnm‐positive S. mutans. Multivariable logistic analysis revealed that the presence of cnm‐positive S. mutans was independently associated with DWI hyperintensities (OR 2.38; 95% CI 1.01–5.61; p = 0.047) after adjusting for several confounding factors. Conclusion This study found an association between the presence of cnm‐positive S. mutans and DWI hyperintensities in patients with acute ICH.

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Section: Methodsmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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cnm‐Positive Streptococcus mutans and diffusion‐weighted imaging hyperintensities in acute intracerebral hemorrhage

Shiga

Aoki

Hosomi

et al. 2021

Euro J of Neurology

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“…15 Whether DWI+ lesions predict clinical events after ICH is still uncertain. Poor functional outcome (assessed by the modified Rankin Scale [mRS] score at 3 months after ICH) was associated with the presence of DWI+ lesions in some studies, 6,16,17 but not others. 9,13 One study of 97 patients found that the presence of DWI+ lesion(s) five days after ICH was associated with a higher risk of both ischaemic stroke as well as a composite of ischaemic stroke, recurrent ICH, and vascular death, during a median follow-up period of 3.5 years.…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted imaging lesions and risk of recurrent stroke after intracerebral haemorrhage

Wiegertjes

Dinsmore

Drever

et al. 2021

J Neurol Neurosurg Psychiatry

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ObjectiveTo determine whether the presence of diffusion-weighted imaging-positive (DWI+) lesions is associated with recurrent stroke after intracerebral haemorrhage (ICH).MethodsThe REstart or STop Antithrombotics Randomised Trial (RESTART) assessed the effect of restarting versus avoiding antiplatelet therapy after ICH on major vascular events for up to 5 years. We rated DWI sequences of MRI done before randomisation for DWI+ lesion presence, masked to outcome and antiplatelet use. Cox proportional hazards regression models were used to quantify associations.ResultsOf 537 participants in RESTART, 247 (median (IQR) age 75.7 (69.6–81.1) years; 170 men (68.8%); 120 started vs 127 avoided antiplatelet therapy) had DWI sequences on brain MRI at a median of 57 days (IQR 19–103) after ICH, of whom 73 (30%) had one or more DWI+ lesion. During a median follow-up of 2 years (1–3), 18 participants had recurrent ICH and 21 had ischaemic stroke. DWI+ lesion presence was associated with all stroke, (adjusted HR 2.2 (95% CI 1.1 to 4.2)) and recurrent ICH (4.8 (95% CI 1.8 to 13.2)), but not ischaemic stroke (0.9 (95% CI 0.3 to 2.5)). DWI+ lesion presence (0.5 (95% CI 0.2 to 1.3)) vs absence (0.6 (95% CI 0.3 to 1.5), pinteraction=0.66) did not modify the effect of antiplatelet therapy on a composite outcome of recurrent stroke.ConclusionsDWI+ lesion presence in ICH survivors is associated with recurrent ICH, but not with ischaemic stroke. We found no evidence of modification of effects of antiplatelet therapy on recurrent stroke after ICH by DWI+ lesion presence. These findings provide a new perspective on the significance of DWI+ lesions, which may be markers of microvascular mechanisms associated with recurrent ICH.Trial registration numberISRCTN71907627.

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“…We have kept on focusing on the associations between glucose-related indices and the occurrence of remote diffusion-weighted imaging (DWI) lesions (R-DWILs) in brain MRI, which was characterized as hyperintensity lesions in DWI with corresponding hypointensity lesions in apparent diffusion coefficient (ADC), remote from hematoma location topographically (3,4). Although commonly subclinical in the acute stage of ICH, R-DWILs portend worse outcomes as reported by previous studies (5)(6)(7)(8)(9). The etiology of R-DWILs is not fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Association Between Insulin Resistance and Remote Diffusion-Weighted Imaging Lesions in Primary Intracerebral Hemorrhage

Zhang

Jin

et al. 2021

Front. Immunol.

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BackgroundAbnormal glucose metabolism was shown to be associated with the occurrence of remote diffusion-weighted imaging lesions (R-DWILs) after primary intracerebral hemorrhage (ICH) onset. Insulin resistance is a metabolic disorder that was regarded as an indicator of chronic systemic inflammation. In this study, we aimed to determine the effect of insulin resistance on the occurrence of R-DWILs in ICH.MethodsPatients with primary ICH within 14 days after onset were prospectively enrolled from November 2017 to October 2019. R-DWILs was defined as remote focal hyperintensity from the hematoma in DWI, with corresponding hypointensity in apparent diffusion coefficient. The homeostasis model assessment of insulin resistance (HOMA-IR) was used for insulin resistance estimation and calculated as fasting insulin (μU/ml) × fasting glucose (mmol/L)/22.5. Patients in our cohort were divided into four groups according to HOMA-IR index quartiles. Logistic regression analysis and smoothing plots were used to evaluate the association of HOMA-IR with R-DWIL occurrence. Sensitivity analysis was performed in non-diabetic patients, non-obese patients, hypertensive ICH patients, and patients 60 years and older separately. The association between HOMA-IR and systemic inflammatory immune indices neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR) was examined with multiple linear regression analysis.ResultsAmong the 345 patients, 54 (15.7%) had R-DWILs. Both the third and fourth quartiles of HOMA-IR index were robustly associated with an increased risk of R-DWIL occurrence (adjusted OR 3.58, 95% CI 1.33-9.65; adjusted OR 3.91, 95%CI 1.47-10.41) when compared with the first quartile. The association was consistent in non-diabetic, non-obese, hypertensive ICH patients, as well as in patients 60 years and older. Furthermore, both NLR and MLR were independently associated with HOMA-IR.ConclusionsOur study suggested that insulin resistance evaluated with HOMA-IR index was independently associated with the presence of R-DWILs in patients with acute and subacute primary ICH. It may provide new insights into the metabolism-related brain injury after ICH ictus.

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A Pooled Analysis of Diffusion-Weighted Imaging Lesions in Patients With Acute Intracerebral Hemorrhage

Cited by 47 publications

References 32 publications

cnm‐Positive Streptococcus mutans and diffusion‐weighted imaging hyperintensities in acute intracerebral hemorrhage

cnm‐Positive Streptococcus mutans and diffusion‐weighted imaging hyperintensities in acute intracerebral hemorrhage

Diffusion-weighted imaging lesions and risk of recurrent stroke after intracerebral haemorrhage

Association Between Insulin Resistance and Remote Diffusion-Weighted Imaging Lesions in Primary Intracerebral Hemorrhage

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