Sean William Wilson MD, Presenter: Nothing to Disclose

Matthew Ryan Plunk MD, Abstract Co-Author: Nothing to Disclose

James Russell Fink MD, Abstract Co-Author: Research support, General Electric Company Research support, Guerbet SA Research support, Bayer AG Research support, Bracco Group Stockholder, General Electric Company

Annemarie Relyea-Chew, Abstract Co-Author: Nothing to Disclose

Hemorrhage into the brain parenchyma can have devastating clinical consequences. While hemorrhage into the basal ganglia is overwhelmingly due to hypertension, hemorrhage in a lobar distribution is more likely to have an underlying vascular or malignant etiology. While it has been recognized that hemorrhage can potentially obscure an underlying lesion in the acute setting, the frequency with which this occurs is not well established. Our goal was to quantify how often repeat imaging in patients with spontaneous, idiopathic lobar hemorrhage reveals an underlying etiology.

Institutional Review Board approval was obtained. A retrospective review was conducted over 54 months to identify patients with lobar distribution intracranial hemorrhage. Imaging and chart review was conducted for individuals with lobar hemorrhage who were evaluated with a combination of CT, MRI, and/or catheter angiography and had subsequent imaging and clinical follow-up within the University of Washington system. Exclusion criteria included patients less than 18 years old, preceding trauma, hemorrhagic transformation of known infarct, and subarachnoid hemorrhage as the predominant feature.

A cohort of 327 patients with spontaneous lobar hemorrhage was identified. A causative etiology was identified on initial imaging in 67 patients (23%). 170 patients (52%) either expired or were lost to follow up before adequate imaging work up was completed. Of the remaining 90 patients who had negative initial imaging and adequate clinical/imaging follow up (mean/median 475 and 354 days) an underlying lesion was discovered in 10 patients (11%).

Repeat imaging was able to reveal an underlying etiology in approximately 11% of patients whose initial exams were negative. This is about half the rate with which the initial imaging for patients with new lobar hemorrhage is able to identify an etiology; routine follow up imaging should be considered when there is a concern for an underlying etiology in patients with spontaneous lobar hemorrhage.

This information on the yield of follow up imaging in idiopathic lobar intracranial hemorrhage would be valuable for clinicians and radiologists in managing these patients.

Wilson, S, Plunk, M, Fink, J, Relyea-Chew, A, The Utility of Follow-up Imaging in Nontraumatic Lobar Intraparenchymal Hemorrhage with Negative Initial Imaging Work-up.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13015748.html