Benefits of early MR-Imaging in patients with acute spontaneous intracerebral hemorrhage: a retrospective study

Background Neuroimaging plays a vital role in the diagnosis of intracerebral hemorrhage (ICH) and in identifying the underlying etiology for appropriate therapeutic approach. This study aims to determine the significance and potential advantages of using early magnetic resonance imaging (MRI) as a diagnostic tool for ICH. Methods This retrospective study included 359 patients with ICH treated at the Department of Neurology, Mannheim University Hospital between January 2017 and December 2021. Patient characteristics, stroke severity and imaging procedures were descriptively analyzed. Factors associated with the choice of imaging modalities were evaluated. The etiology of hemorrhage was retrospectively analyzed using the existing data. We recorded the reassignment of ICH etiology by comparing the assessment after first sole review of CT scan and then subsequent MRI review. The overall rate of reassignments and the reassignments per CT-based initial etiology were analyzed. Results In the sample of 359 patients with ICH (mean age 73.1 years, 55.4% male), patients receiving an additional MRI were significantly younger (p < .001) and were less severely affected by stroke (median NIHSS score 5 vs. 15, p < .001). MRI was performed significantly less frequently in patients who died during hospitalization (11.7% vs. 63.9%, p < .001). MRI led to a reassignment of ICH etiology in 48.2% of cases (80/166), uncovering unknown underlying causes in 69% of cases (49/71). Reassignment occurred most frequently in patients with a CT-based diagnosis of hypertensive ICH (18/50). The most frequent reassigned etiologies after MR imaging were cerebral amyloid angiopathy (CAA; 36 patients) and secondary hemorrhage of an ischemic stroke (30 patients). Conclusions Early MR imaging in patients with ICH improves the determination of underlying etiology and the conception of an appropriate treatment approach, potentially contributing to better patient outcomes.