Nikolaos Mouchtouris1, Fadi Al Saiegh1, Nohra Chalouhi1, Ahmad Sweid1, Emily J Papai2, Daniella Wong2, Julie Kim2, Austin Saline2, David Nauheim2, Reid Gooch1, Stavropoula Tjoumakaris1, Robert Rosenwasser1, Pascal Jabbour3,4. 1. Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA. 2. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA. 3. Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA. pascal.jabbour@jefferson.edu. 4. Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA. pascal.jabbour@jefferson.edu.
Abstract
PURPOSE: Follow-up MRI/MRA is historically obtained as outpatient when patients with a spontaneous intracerebral hemorrhage (ICH) have an initial MRI/MRA that is negative for an underlying structural lesion. However, the utility of repeating MR imaging in a delayed fashion remains uncertain. METHODS: We retrospectively reviewed 396 patients with spontaneous ICH admitted at our institution between 2015 and 2017 and selected those whose initial MRI/MRA was negative for an underlying structural lesion and those who underwent follow-up MR imaging in a delayed fashion. RESULTS: A total of 113 patients met the study criteria. The average age of those with negative follow-up MRI/MRA was 65.0 ± 12.6 (IQR: 55.0-74.0) years old. None of the 113 patients with a negative inpatient MRI/MRA had an underlying structural lesion on follow-up MRI/MRA (0%, 95% CI 0.0-0.032, p < 0.001). The mean time of the follow-up imaging from the initial study was 105.7 days (median: 62 days; IQR: 42.5-100.5). Of the 113, 83 (73.5%) underwent follow-up MRI with and without gadolinium, while 30 (26.5%) patients did not receive gadolinium. CONCLUSION: Delayed follow-up MRI in patients with a negative initial MRI/MRA for workup of spontaneous ICH was not diagnostic in any of the patients included in the study. Our study suggests that a routine follow-up MRI for this patient population is not necessary.
PURPOSE: Follow-up MRI/MRA is historically obtained as outpatient when patients with a spontaneous intracerebral hemorrhage (ICH) have an initial MRI/MRA that is negative for an underlying structural lesion. However, the utility of repeating MR imaging in a delayed fashion remains uncertain. METHODS: We retrospectively reviewed 396 patients with spontaneous ICH admitted at our institution between 2015 and 2017 and selected those whose initial MRI/MRA was negative for an underlying structural lesion and those who underwent follow-up MR imaging in a delayed fashion. RESULTS: A total of 113 patients met the study criteria. The average age of those with negative follow-up MRI/MRA was 65.0 ± 12.6 (IQR: 55.0-74.0) years old. None of the 113 patients with a negative inpatient MRI/MRA had an underlying structural lesion on follow-up MRI/MRA (0%, 95% CI 0.0-0.032, p < 0.001). The mean time of the follow-up imaging from the initial study was 105.7 days (median: 62 days; IQR: 42.5-100.5). Of the 113, 83 (73.5%) underwent follow-up MRI with and without gadolinium, while 30 (26.5%) patients did not receive gadolinium. CONCLUSION: Delayed follow-up MRI in patients with a negative initial MRI/MRA for workup of spontaneous ICH was not diagnostic in any of the patients included in the study. Our study suggests that a routine follow-up MRI for this patient population is not necessary.
Authors: J Claude Hemphill; Steven M Greenberg; Craig S Anderson; Kyra Becker; Bernard R Bendok; Mary Cushman; Gordon L Fung; Joshua N Goldstein; R Loch Macdonald; Pamela H Mitchell; Phillip A Scott; Magdy H Selim; Daniel Woo Journal: Stroke Date: 2015-05-28 Impact factor: 7.914