ABSTRACT NUMBER: ESOC2026A1001 REMOTE DWI LESIONS IN SPONTANEOUS INTRACEREBRAL HEMORRHAGE: ASSOCIATIONS WITH SMALL VESSEL DISEASE BURDEN AND LESION LOCATION

Abstract Background and aims Remote diffusion-weighted imaging lesions (rDWIL) are frequently observed on MRI of acute spontaneous intracerebral hemorrhage (ICH). Their underlying mechanisms and clinical significance remain unclear. We investigated the prevalence, location and clinical and imaging correlates of rDWIL in ICH. Methods We retrospectively analyzed patients with spontaneous ICH admitted between 2018 and 2022 to three hospitals. Clinical and CT/MRI data were assessed. rDWIL and ICH location were categorized as lobar, deep or mixed. Univariate comparisons and multivariable regression analyses (adjusted odds ratio (aOR); 95% confidence interval (CI)) were performed to assess associations with rDWIL. Results Among 185 patients (median age 76 years, 61-81 IQR, 53% female), 46 (25%) had rDWIL. Clinically, rDWIL presence was associated with chronic kidney disease (aOR = 2.75, 95% CI 1.09-6.91) and higher median diastolic blood pressure at admission (aOR = 1.02, 95% CI 1.01-1.04 per mmHg). Regarding imaging, rDWIL were independently associated with higher total small vessel disease (SVD) burden (aOR = 1.45, 95% CI 1.04–2.01). Most rDWIL were strictly lobar (74%). In rDWIL-positive ICH, strictly lobar rDWIL were more frequent in lobar than deep/mixed ICH (94 vs 62%, P = 0.034). Strictly deep rDWIL were confined to deep/mixed ICH. Patients with strictly rDWIL were younger (58 vs 78 years, P < 0.001), had higher median diastolic blood pressure at admission (114 vs 88 mmHg, P = 0.04) and more frequently strictly deep cerebral microbleeds (38 vs 6%, P = 0.04). Conclusions rDWIL in spontaneous ICH are associated with markers of vascular end-organ damage and SVD burden. Strictly lobar and strictly deep rDWIL may reflect different underlying mechanisms. Conflict of interest Ayadi: nothing to disclose; Rangus: nothing to disclose, Galinovic: nothing to disclose; Seiffge: nothing to disclose; Nolte: received honoraria for lectures/advisory boards from AstraZeneca, Bayer and Pfizer.