Factors Associated With Remote Diffusion-Weighted Imaging Lesions In Spontaneous Intracerebral Hemorrhage

ObjectiveOur study aims to demonstrate the clinical and imaging characteristics of remote diffusion-weighted imaging lesion(R-DWIL)in spontaneous intracerebral hemorrhage(sICH)patients,and analyze the factors associated with its occurrence.We further explore its formation mechanisms.MethodsWe consecutively collected data with sICH patients admitted to the Department of Neurology,The Second Affiliated Hospital of Zhejiang University,School of Medicine from November 2016 to December 2017.In these patients,cerebral Computed Tomography(CT)or CT angiography(CTA)were taken to confirm the diagnosis of sICH,additional imaging tests were also applied to exclude secondary ICH.Patients only presented isolated intraventricular hemorrhage were also excluded.Cerebral magnetic resonance imaging(MRI)protocol including DWI,apparent diffusion coefficient(ADC)and fluid attenuated inversion recovery(FLAIR)were performed within 28 days after ICH onset.R-DWIL was defined as a hyperintensity signal in DWI with corresponding hypointensity in ADC and at least 20 mm apart from the hematoma.We compared two groups of patients with or without R-DWIL with the demographic and clinical characteristics,laboratory parameters and imaging characteristics,by using univariate and multivariate analysis.ResultsOf the 222 patients enrolled,41 patients(18.5%)had one or more R-DWILs(median 1,range 1-8).A total of 75 R-DWILs were observed.The median diameter of R-DWILs was 7 mm(range 2-20 mm).Among these lesions,the cortical and subcortical areas of lobes were the predominant locations with a proportion of 77.3%,occipital lobe(30.7%)in particular.Thirty-six(48%)lesions were ipsilateral to the hematoma.No matter where the parenchymal hemorrhage originated,such as the deep structure,lobe,brainstem and cerebellum,R-DWIL could present with no significant difference in statistics(p=0.708).Twelve patients were found having more than one lesion,with 5 among which showed R-DWILs in multiple cerebral arterial territories.However,we found no statistical difference(p=0.322)between two groups in the history of atrial fibrillation(AF),which is the cardiac disease related with cardioembolic infarction.In multivariate logistic modeling,higher fasting glucose(OR 1.231;95%CI 1.035-1.465;p=0:019)and more severe white matter hyperintensity(WMIH)(OR 6.589;95%C 2.975-14.592;p<0.001)were independent factors related to the presence of R-DWILs.ConclusionsOur study observed that approximately one fifth of sICH patients showed coexistence of R-DWIL.The total number of R-DWIL in single patient was varied.The occurrence of R-DWIL was irrelative to the location of hematomas.The cortical and subcortical areas were its preferential locations.Higher fasting glucose and more severe WMH were associated with R-DWIL occurrence in sICH.