Diagnostic Utility of MRI in Intracerebral Hemorrhage

描述（由申请人提供）：脑出血引起的中风占中风的15-20%，是所有中风中致残率和死亡率最高的。这项研究的总体目标是衡量新的、最先进的脑成像技术对这些患者的诊断和治疗的影响，希望能改善患者的预后。在本研究中，我们将研究磁共振成像（MRI）在血肿急性期和慢性期的诊断率，包括对新型MRI序列的评估。在这项为期5年的研究中，160例连续住院的脑出血（ICH）患者通过计算机断层扫描（CT）诊断，在症状出现后48小时内接受MRI检查。在我们的初步分析中，治疗中风的神经科医生会将患者前瞻性地分类到特定的诊断类别中，首先是在审查临床数据和CT扫描之后，然后是在进一步审查MRI之后。常规脑血管造影和病理也将在预先确定的患者亚组中获得。在第二个分析中，CT（结合血管造影）和MRI将分别由一个不考虑其他所有数据的评审小组独立解释。MRI的诊断率将与CT和血管造影的联合诊断率进行比较。最终（金标准）诊断将由外部裁决委员会根据所有可用的临床和成像数据（MRI结果除外）进行审查。在探索性分析中，CT和MRI将分别由独立和盲法裁判独立解释，并与病理结果进行比较。最后，将新型MRI序列的诊断效用与传统序列进行比较。这项研究的结果将用于评估MRI在确定脑出血病因方面的价值，以及特定的MRI序列是否对确定诊断和管理计划特别有用。此外，将评估60天内重复MRI的诊断效用。最后，我们将评估MRI是否会减少这些患者对脑血管造影的需求。该研究将为MRI对自发性脑出血急性期和慢性期患者的有用性提供有价值的信息。我们预计这项研究的结果将对脑出血患者的管理产生重大影响，并将促进在这些患者中使用MRI的实践指南的发展。

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.