Intracerebral hemorrhage diagnosis

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Intracerebral hemorrhage diagnosis

Computed tomography

Noncontrast computed tomography (NCCT) is the gold standard to detect intracerebral hemorrhage (ICH) in patients presenting with acute focal syndromes.

Although CT remains important in the acute setting, MR imaging has proved invaluable for diagnosis and characterization of intracranial hemorrhage.

Non-contrast head CT, given its availability and high sensitivity in detecting blood products, is frequently the first tool to readily detect ICH; however, different types of hemorrhages may share a common appearance on CT and the optimal therapeutic approach varies depending on etiology. An additional diagnostic work-up is frequently indicated to make the final diagnosis and to assist in urgent patient management. CT- and MR angiography, and digital angiography can diagnose vascular anomalies, CT venography can reveal cerebral vein thrombosis, diffusion-weighted MRI (DWI) may show hemorrhagic transformation of an infarct, and susceptibility-weighted MRI (SWI) may detect hypertensive and amyloid angiopathy-related microbleeds. MR also has a major role in revealing underlying etiologies such as cavernoma, primary brain tumor or metastases. These imaging tools assist in determining the cause of ICH, and also in assessing the risk of deterioration. Prognostic factors such as size, location, mass effect, and detection of the “spot sign” all play an important role in foreseeing possible deterioration, thus allowing prompt intervention 1).

Intracerebral hemorrhage volume is a powerful predictor of 30-day mortality after spontaneous intracerebral hemorrhage (ICH). Kothari et al., compared a bedside method of measuring CT ICH volume with measurements made by computer-assisted planimetric image analysis 2).

MRI

Diffusion weighted magnetic resonance imaging (DW-MRI) may be considered as the initial screening tool for imaging patients presenting with focal neurologic symptoms suggestive of stroke.

DW-MRI at b1000 has a diagnostic yield similar to noncontrast computed tomography (NCCT) for detecting ICH and superior to NCCT for detecting ischemic stroke (IS). Therefore, DW-MRI may be considered as the initial screening tool for imaging patients presenting with focal neurologic symptoms suggestive of stroke 3).

Biomarkers

Results indicated that circulating miR-181b, miR-223, miR-155 and miR-145 in plasma samples could be served as a potential noninvasive tool in ICH detection 4).

References

1)

Eliahou R, Auriel E, Gomori M, Sosna J, Honig A. [SPONTANEOUS PARENCHYMAL INTRACRANIAL HEMORRHAGE – A DIAGNOSTIC CHALLENGE]. Harefuah. 2018 Mar;157(3):158-161. Hebrew. PubMed PMID: 29582945.
2)

((Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996 Aug;27(8):1304-5. PubMed PMID: 8711791.
3)

Keigler G, Goldberg I, Eichel R, Gomori JM, Cohen JE, Leker RR. Diffusion-weighted Imaging at b1000 for Identifying Intracerebral Hemorrhage: Preliminary Sensitivity, Specificity, and Inter-rater Variability. J Stroke Cerebrovasc Dis. 2014 May 1. pii: S1052-3057(14)00065-2. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.005. [Epub ahead of print] PubMed PMID: 24795096.
4)

Gareev I, Yang G, Sun J, Beylerli O, Chen X, Zhang D, Zhao B, Zhang R, Sun Z, Yang Q, Li L, Pavlov V, Safin S, Zhao S. Circulating MicroRNAs as a Potential Non-invasive Biomarkers of Spontaneous Intracerebral Hemorrhage. World Neurosurg. 2019 Sep 13. pii: S1878-8750(19)32446-5. doi: 10.1016/j.wneu.2019.09.016. [Epub ahead of print] PubMed PMID: 31525485.

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