Abstract WP310: The Role of Follow-Up Magnetic Resonance Imaging in Uncovering Cryptogenic Etiologies of Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) is a common neurologic diagnosis characterized by the accumulation of blood within the brain parenchyma. While the most common etiology of nontraumatic ICH is hypertension, Magnetic Resonance Imaging (MRI) is often performed to identify alternative ICH etiologies. Sometimes additional follow-up MRI is performed to assess brain parenchyma for etiologic lesions after time is given for blood products to clear. Research is limited in evaluating the utility of such follow-up imaging. This retrospective chart review study was conducted to quantify the frequency of and risk factors associated with a change in ICH etiology on follow-up MRI. Methods: ICH cases at an academic, public, comprehensive stroke center from April 2017 to December 2024 were identified using, SlicerDicer, an Epic integrated informatics tool. Information on patient demographics, medical history, social history, initial and follow-up imaging results, and follow-up visits were collected by chart review. Patients were included if they received MRI inpatient and were recommended to receive follow-up MRI 2-3 months later as an outpatient. Correlational analysis between odds of change in etiology and clinical or demographic variables was analyzed using Firth’s logistic regression. Results: This study included 65 patients with a mean age of 61.5 (SD=14.4). 28 (43%) were female assigned at birth. 36 (55%) patients with ICH received both an inpatient and follow-up MRI leaving 29 (45%) lost to follow-up after discharge. Of those who completed follow-up MRI, the underlying etiology of ICH was identified in 4 (11%) cases. Repeat imaging changed management for only 1 (3%) patient. Correlational analysis showed no significant association with changes in etiology on repeat MRI. Conclusions: In conclusion, follow-up MRI rarely changed clinical management in this sample, and no clinical or demographic factors were associated with a statistically significant increased odds of finding an alternative etiology of ICH. Additionally, nearly half of the patients recommended to receive outpatient MRI were lost to follow-up. Future work will aim to further characterize individuals who are most likely to benefit from follow-up MRI by predictive modeling to reduce healthcare expenditure and unnecessary imaging. Additionally, future work should aim to evaluate barriers to outpatient follow-up MRI when indicated.