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Gradient Echo Magnetic Resonance Imaging in the Prediction of Hemorrhagic vs Ischemic Stroke
A Need for the Consideration of the Extent of Leukoariosis
Dong-Eog Kim, MD;
Hee-Joon Bae, MD;
Seung-Hoon Lee, MD;
Ho Kim, PhD;
Byung-Woo Yoon, MD, PhD;
Jae-Kyu Roh, MD, PhD
Arch Neurol. 2002;59:425-429.
Background Multifocal signal loss lesion (MSLL) on gradient echo magnetic resonance
imaging (GE-MRI) may reflect bleeding-prone microangiopathy. However, MSLLs
are also known to be associated with leukoariosis; leukoariosis is commonly
associated with occlusive-type vascular lesions.
Objective To determine whether MSLL on GE-MRI is significantly associated with
the type of stroke—intracerebral hemorrhagic (ICH) stroke more often
than an ischemic stroke (infarction)—regardless of the extent of leukoariosis.
Patients and Methods We studied 91 patients who had an acute stroke and were admitted to
the Department of Neurology, Seoul National University Hospital, Seoul, South
Korea, from March 1, 1997, to July 31, 1998. These patients underwent both
conventional MRI and GE-MRI. The GE-MRI was used to count MSLLs. We also counted
lacunae and classified leukoariosis (none or mild and advanced). Multiple
logistic regression analysis was used to test for MSLL–leukoariosis
interaction association with the type of stroke (ICH over infarction) and
to evaluate the relative contribution of an MSLL—adjusted for age, sex,
and lacunae—in discriminating the type of stroke.
Results The association between MSLL and ICH statistically significantly differed
by leukoariosis (P = .003 for MSLL–leukoariosis
interaction term). The MSLL count on GE-MRI was significantly associated with
the type of stroke (ICH over infarction; odds ratio, 2.46; 95% confidence
interval, 1.38-4.39) when leukoariosis was classified as none or mild. When
leukoariosis was classified as advanced, there was a decrease in the odds
ratio of MSLL to 0.99 (95% confidence interval, 0.94-1.04).
Conclusions Our findings indicate that MSLL on GE-MRI is a predictor of ICH vs infarction
in patients with no or mild leukoariosis, but not in patients with advanced
leukoariosis. Therefore, in the evaluation of GE-MRI for a bleeding-prone
microangiopathy, the extent of leukoariosis should be considered.
From the Department of Neurology, Seoul National University College
of Medicine (Drs D.-E. Kim, Lee, Yoon, and Roh), Department of Neurology,
Eulji General Hospital, Eulji University School of Medicine (Dr Bae), and
the Department of Epidemiology and Biostatistics, School of Public Health,
Seoul National University (Dr H. Kim), Seoul, South Korea.
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