Associations of Cerebral Small Vessel Disease on the Features of Hematoma and Hematoma Expansion in Intracerebral Hemorrhage.

INTRODUCTION: Several early noncontrast CT (NCCT) signs of spontaneous intracerebral hemorrhage (ICH) can predict hematoma expansion (HE). However, the associations of underlying cerebral small vessel disease (SVD) on early NCCT signs and HE have been less explored.

METHODS: We conducted an analysis of all patients with spontaneous supratentorial ICH and received follow-up imaging between 2016-2020 at a stroke center. The early NCCT signs were categorized as shape or density signs. HE was defined as an increase in hematoma volume ≥6 ml or 33% from baseline. The severity of SVD was assessed by both a 3-point CT-based and a 4-point MRI-based SVD scores. Regression models were used to examine the associations between SVD score and hematoma volume, NCCT signs, and HE.

RESULTS: A total of 328 patients (median age: 64 years; 38% female) were included. The median baseline ICH volume was 8.6 ml, with 38% of the patients had shape signs and 52% had density signs on the initial NCCT. Higher MRI-SVD scores were associated with smaller ICH volumes (P = 0.0006), fewer shape (P = 0.001) or density signs (P = 0.0003). Overall, 16% of patients experienced HE. A higher MRI-SVD score was inversely associated with HE (adjusted odds ratio 0.71, 95% CI 0.53 - 0.96). Subgroup analysis revealed that this association was primarily observed in patients who were younger (< 65 years), male, had deep hemorrhage, or did not meet the criteria for cerebral amyloid angiopathy diagnosis.

CONCLUSIONS: In patients with spontaneous ICH, a more severe SVD was associated with smaller hematoma volume, fewer NCCT signs, and a lower risk of HE. Further research is required to investigate why a higher burden of severely diseased cerebral small blood vessels is associated with less bleeding.