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The relation between acute intracerebral hemorrhage and diffusion-weighted imaging lesions: a meta-analysis

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Abstract

Diffusion-weighted imaging lesions in intracerebral hemorrhage are related to a higher risk of recurrent intracerebral hemorrhage, cognitive damage, and mortality. However, it has been reported that the relationship between the risk of diffusion-weighted imaging lesions and intracerebral hemorrhage subtype or the possible risk factors for diffusion-weighted imaging lesions is variable. This meta-analysis was performed to evaluate this relationship. A systematic literature search up-to August 2020 was performed and 12 studies included 2815 subjects at the baseline with intracerebral hemorrhage. Odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs) was calculated to evaluate the prognostic role of diffusion-weighted imaging lesions and intracerebral hemorrhage subtype and investigated the possible risk factors for diffusion-weighted imaging lesions using the dichotomous and continuous methods with a random or fixed-effect model. Lobar intracerebral hemorrhage was not significantly related to a higher rate of diffusion-weighted imaging lesions (OR, 1.01; 95% CI, 0.75–1.36, p = 0.94) compared to the non-lobar intracerebral hemorrhage. Also, history of diabetes mellitus (OR, 1.15; 95% CI, 0.83–1.60, p = 0.39); history of smoking (OR, 0.95; 95% CI, 0.68–1.33, p = 0.76); history of hypercholesterolemia (OR, 1.04; 95% CI, 0.73–1.48, p = 0.83); and history of ischemic stroke (OR, 1.63; 95% CI, 0.57–4.66, p = 0.36) were not significantly related to higher rate of diffusion-weighted imaging lesions compared to no history of those factors. However, the history of hypertension was significantly related to a higher rate of diffusion-weighted imaging lesions (OR, 1.33; 95% CI, 1.04–1.70, p = 0.02) compared to no history of hypertension. Also, Subjects with diffusion-weighted imaging lesions had a greater decrease in systolic pressure in the acute phase of the intracerebral hemorrhage (MD, 10.23; 95% CI, 7.41–13.06, p < 0.001) compared to without diffusion-weighted imaging lesions. Based on this meta-analysis, the history of hypertension may have an independent risk relationship with a higher rate of diffusion-weighted imaging lesions. Also, subjects with diffusion-weighted imaging lesions had a greater decrease in systolic pressure in the acute phase of the intracerebral hemorrhage compared to those without diffusion-weighted imaging lesions. This relationship forces us to recommend that identification of diffusion-weighted imaging lesions might add appreciated evidence to evaluate the progression of the underlying micro-angiopathy especially in subjects with a history of hypertension. Though further studies are needed to define the mechanisms by which these lesions may lead to cognitive damage and stroke reappearance.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

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Funding

There was no external funding for this study itself. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

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Authors and Affiliations

  1. Shenzhen Clinical Medical College of Guangzhou University of Chinese Medicine, Doctor Degree of Similar Professional Qualification, Guangzhou, 51000, Guangdong, China

    Xiang Li

  2. Department of Radiology, The First Hospital of Jilin University, Changchun, 130000, Jilin, China

    Bei Zhang

  3. Department of Imaging, Shenzhen Longgang Central Hospital, Shenzhen, 518116, Guangdong, China

    Mingwu Lou

Authors
  1. Xiang Li
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  2. Bei Zhang
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  3. Mingwu Lou
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Contributions

Conception and design: ML. Administrative support: All authors. Provision of study materials or subjects: All authors. Collection and assembly of data: XL, BZ. Data analysis and interpretation: All authors. Manuscript writing: All authors. Final approval of manuscript: All authors. All authors have read and approved the manuscript.

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Correspondence to Mingwu Lou.

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Xiang Li declares that he has no conflict of interest. Bei Zhang declares that he/she has no conflict of interest, Mingwu Lou declares that he/she has no conflict of interest.

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Li, X., Zhang, B. & Lou, M. The relation between acute intracerebral hemorrhage and diffusion-weighted imaging lesions: a meta-analysis. J Thromb Thrombolysis 52, 962–970 (2021). https://doi.org/10.1007/s11239-021-02430-6

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