Gradient echo magnetic resonance imaging in the prediction of hemorrhagic vs ischemic stroke - A need for the consideration of the extent of leukoariosis

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 (101) 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.