Abstract TP373: White Matter Hyperintensity in Adult Patients with Cerebral Cavernous Malformations Reduced Hemorrhage Risk

Background: Hemorrhage in cerebral cavernous malformations (CCMs) is a critical cause of patients’ mortality and disability, making the exploration of risk factors for CCM hemorrhage essential. This study aimed to assess the prevalence of white matter hyperintensity (WMH) in adult patients with cerebral cavernous malformations (CCMs) and to investigate the potential association between WMH and hemorrhage risk in this population. Methods: A total of 1707 CCM patients were retrospectively screened at our center between January 1996 and April 2022. Inclusion criteria required a CCM diagnosis confirmed by magnetic resonance imaging (MRI). WMH was graded using modified Fazekas scores, and its prevalence was assessed. Patients were dichotomized into hemorrhagic and non-hemorrhagic groups based on MRI findings. Univariate and multivariate regression analyses were performed to evaluate the association between WMH and hemorrhage risk. Propensity score matching (PSM) analysis were used to adjust for potential confounding variables. Subgroup analysis was employed to assess differences among distinct population groups. Results: The prevalence of WMH was 45.34% (95% CI: 42.98% - 47.70%) in CCM patients. Compared with the hemorrhagic group, patients in the non-hemorrhagic group demonstrated a significantly higher prevalence of WMH (OR 0.776, 95% CI: 0.665 - 0.907; p = 0.001). A significant inverse correlation was observed between WMH severity (modified Fazekas scores) and both hemorrhage rate (scores 0 - 3: 35.91%, 27.37%, 14.91%, and 11.59%, respectively; p for trend < 0.001) and hemorrhage volume (scores 0 - 3: 1.38 ± 5.60 mL vs. 0.93 ± 3.95mL, p < 0.01; vs. 0.56 ± 2.51 mL, p < 0.001; and vs. 0.28 ± 1.20mL, p < 0.001). Subgroup ( p = 0.030) and PSM ( p = 0.009) analyses consistently revealed that elderly patients with WMH had significantly lower bleeding risk . Conclusions: CCM patients with concomitant WMH have a lower risk of hemorrhage, particularly in elderly patients. Prospective multicenter cohort studies are needed to validate these findings and explore the underlying mechanisms.