High Incidence of Microbleeds in Hemodialysis Patients Detected by T2*-Weighted Gradient-Echo Magnetic Resonance Imaging

Abstract

The incidence and characteristics of microbleeds in hemodialysis (HD) patients were investigated to elucidate the clinical significance with T 2 *-weighted gradient-echo magnetic resonance (MR) imaging. The 57 patients with chronic renal failure maintained by HD had no previous history of stroke. The control group consisted of 53 patients without previous history of stroke or chronic renal failure. The incidence and the number of microbleeds were assessed in the HD and control groups. The findings of microbleeds with T 2 *-weighted gradient-echo MR imaging were compared with those of T 1 -and T 2 -weighted MR imaging in HD patients. The incidence of microbleeds was significantly greater in the HD patients compared with the control patients. T 2 * -weighted gradient-echo imaging revealed a total of 44 microbleeds in 11 HD patients. T 2 -weighted imaging demonstrated 13 of 44 microbleeds as hyperintensity, whereas T 1 -weighted imaging demonstrated 12 lesions as hypointensity. T 2 -and T 1 -weighted imagings did not demonstrate any findings in 31 and 32 lesions, respectively. T 2 * -weighted gradientecho MR imaging is effective to detect microbleeds which may be a predictor of intracerebral hemorrhage in HD patients and should be included in the protocol for the study of cerebrovascular disease, because T 2 -and T 1 -weighted MR imaging recognizes microbleeds as lacunar infarction.

Cognitive Disorders and Dementia in CKD

“…The incidence of cerebral microbleeds is higher in patients undergoing hemodialysis 49 and also in patients with a more moderate decrease in renal function. 50 In two other studies performed in patients with ischemic stroke, similar associations between chemical markers of CKD and cerebral microbleeds have been observed.…”

Cerebral Microbleeds and Intracerebral Hemorrhages in Patients on Maintenance Hemodialysis

“…23,24 In this study of patients undergoing chronic dialysis, the MB-positive ratio of patients undergoing hemodialysis (35%) was higher than that of asymptomatic or healthy elderly individuals (about 5%-6%), 23,24 but the MB-positive ratio of patients with old intracerebral hemorrhage (71%) was similar to that of patients with primary intracerebral hemorrhage (23%-71.4%) reported in the literature. 7,8,10,12,16 Yokoyama et al 25 reported no statistically significant correlation between the duration of hemodialysis history and MBs in 57 patients with chronic renal failure maintained by hemodialysis. Our study evaluated more patients than theirs (80 vs 57).…”

Intravenous Recombinant Tissue Plasminogen Activator Therapy for Stroke Patients Receiving Maintenance Hemodialysis: The Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement (SAMURAI) rt-PA Registry

“…A unique finding of the present study was the ectopic hematoma after rt-PA in patient 4. Since 19–35% of patients receiving HD had cerebral microbleeds documented on T 2 *-weighted, gradient echo MRI [11,12], such microbleeds might have grown to be an overt hematoma in this patient. Receiving rt-PA soon after stopping HD (although activated partial thromboplastin time returned to the normal range) and the high baseline blood pressure that required IV antihypertensive therapy may have triggered this ICH; the coexistence of such conditions may be a contraindication to rt-PA.…”