Objective:

The objective of this study is to identify the diagnostic value of magnetic resonance imaging (MRI) in the acute setting of intraparenchymal hemorrhage (IPH).

Background:

Nontraumatic IPH can be due to a variety of etiologies including but not limited to uncontrolled hypertension, vascular abnormalities, and brain tumors. The leading cause of nontraumatic IPH is uncontrolled hypertension. Computed tomography (CT) of the brain is the initial diagnostic test with high sensitivity and specificity for diagnosing acute intracerebral hemorrhage (ICH). MRI can be obtained to further elucidate the underlying cause, especially in cases where the etiology is unclear.

Design/Methods:

This is a single center, retrospective, chart-review study of the medical records of 287 patients admitted to Loma Linda University Medical Center (LLUMC) for IPH from January 1, 2021 to April 30, 2023. Collected data included patient demographics, comorbidities, imaging results, and characteristics of the IPH, including volume, location, and ICH score. Patients with traumatic IPH, subarachnoid hemorrhages (SAH), and without MRI studies were excluded.

Results:

Of 287 patients, 110 (52.7% female, mean age of 64.9 years), met inclusion criteria. The mean time from admission to MRI is 3.2 ± 2.3 days. Twenty-three patients (20.9%) had MRI suggested etiology of IPH: hemorrhagic conversion of an ischemic stroke (6.4%); vascular abnormalities (5.4%): cavernoma (1.8%), AVF (0.9%), and others (2.7%); cerebral amyloid angiopathy (5.5%); and related to malignancy (3.6%).

Conclusions:

In our study, MRI brain in the acute non-traumatic IPH revealed a suggestive etiology in 20.9%. This is a modest yield, and whether or not routine MRI should be obtained for every acute nontraumatic IPH needs further investigation in larger clinical trials.