Significance of Multifocal Hypointense Cerebral Lesions on Gradient-echo MRI in Patients with Hypertension or Hypertensive Intracerebral Hemorrhage

ABSTRACT

BACKGROUND: Multifocal hypointense cerebral lesions (MHCLs) manifesting as minute round signal loss on T2*-weighted gradient echo MR imaging (GE-MRI), are known to be frequently detected in chronic hypertensive patients. The purpose of this study was to elucidate the correlation among hypertension (HTN), intracerebral hemorrhage (ICH), and MHCLs. METHODS: We prospectively examined GE-MRI in 104 patients with HTN (40 ICH and 64 non-ICH patients) and 72 age and sex matched controls. MHCLs on GE-MRI were counted by two neurologists separately and determined as abnormal by consensus, and the number of MHCLs in each subject was graded as 0 (the number of MHCLs 0), 1 (1-5), and 2 (>5). RESULTS: MHCLs were found in 71 of 104 patients with HTN (68.3%) and in 11 of 72 controls (15.3%). The grade of MHCLs was significantly correlated with HTN (p<0.001). In addition, MHCLs were discovered in 34 of 40 hypertensive patients with ICH (85%) and in 37 of 64 hypertensive patients without ICH (57.8%). The degree of MHCLs was more severe in the former than that in the latter with statistical significance (p<0.005). Multivariate analysis revealed that only HTN and the presence of ICH were the independent risk factors. CONCLUSIONS: Microaneurysm or microbleeding, which has been known as one of the characteristic findings of hyper-tensive microangiopathy, may be shown as MHCLs on GE-MRI. In this study, the positive correlation between MHCLs and HTN was clear. Moreover, we also found that in hypertensive patients with ICH, MHCLs are more fre-quently seen than in patients without ICH. These suggest the causal relationship between MHCLs and ICH. Further cohort study would be necessary in order to confirm this suggestion.