Diagnostic Utility of MRI in Intracerebral Hemorrhage

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DESCRIPTION (provided by applicant): Stroke caused by bleeding into the brain accounts for 15-20% of strokes and has the highest associated disability and death rate of all strokes. The overall goal of this research is to measure the impact of new, state-of the art brain imaging technology on the diagnosis and treatment of these patients with the hope to improve patient outcome. In the proposed study, we will investigate the diagnostic yield of Magnetic Resonance Imaging (MRI) in both the acute and chronic phase of the hematoma, including the evaluation of novel MRI sequences. During this 5-year study, 160 consecutive inpatients with intracerebral hemorrhage (ICH) diagnosed by computer tomography (CT) will undergo MRI within 48 hours of symptom onset. In our primary analysis, patients will be prospectively categorized into specific diagnostic categories by the treating stroke neurologist, first after review of the clinical data and the CT scan, and then again after additional review of the MRI. Conventional cerebral angiography and pathology will also be obtained in predefined subgroups of patients. In a second analysis CT (combined with angiography) and MRI will each be independently interpreted by an adjudication panel that is blinded to all other data. The diagnostic yield of MRI will be compared with the combined diagnostic yield of CT and angiography. The final (gold standard) diagnosis will be determined by an outside adjudicated committee based on the review of all available clinical and imaging data except for the MRI results. In an exploratory analysis, the CT and MRI will each be independently interpreted by independent and blinded adjudicators and compared with the pathology results. Finally, the diagnostic utility of novel MRI sequences will be compared with that of the conventional ones. The results of this study will be used to assess the value of MRI in determining ICH etiology as well as whether specific MRI sequences are particularly useful to determine the diagnosis and management plan. Furthermore, the diagnostic utility of a repeated MRI at 60 days will be assessed. Finally, we will assess whether MRI will reduce the need for cerebral angiography in these patients. The study will provide valuable information about the usefulness of MRI in patients with spontaneous ICH in both the acute and chronic phase. We anticipate that the findings from this study will have a major impact on the management of ICH patients and will facilitate the development of practice guidelines for the use of MRI in these patients.