Background: Intracranial arterial dolichoectasia (IADE) is associated with cerebral small vessel disease (CSVD) in populations with ischemic stroke. Whether IADE is related to CSVD markers in patients with intracerebral hemorrhage (ICH) is unclear but might be relevant for CSVD diagnosis and prognosis. We aimed to investigate the prevalence and associations of IADE in patients with ICH.

Methods: We included consecutive patients with ICH between February 2016 and September 2023. IADE was determined using magnetic resonance angiography based on validated scales assessing vessel diameter, length, and tortuosity. Neuroimaging markers of CSVD were investigated using validated magnetic resonance imaging rating scales. Left ventricular mass (LVM) was determined from transthoracic echocardiography. Multivariable binary logistic regression analyses were used to evaluate associations between IADE and CSVD.

Results: We included 138 patients with a mean age of 66.7±11.8 years, 58.0% men. IADE was present in 16 patients (11.6%). LVM was greater in patients with IADE (183.0±61.3 g versus 155.3±51.2 g, P=0.04). Patients with ICH and IADE had significantly higher proportions of deep lacunes (43.8% versus 18.0%, P=0.02) and deep cerebral microbleeds (56.3% versus 27.1%, P=0.02) compared with individuals without IADE. IADE was independently associated with deep lacunes (adjusted odds ratio [OR], 3.10 [95% CI, 1.02-9.55], P=0.04), severe periventricular white matter hyperintensities (adjusted OR, 3.29 [95% CI, 1.00-10.94], P=0.04), and deep cerebral microbleeds (adjusted OR, 2.80 [95% CI, 1.04-8.65], P=0.04). Among these CSVD markers, IADE had a high predictive value for deep cerebral microbleeds with a receiver operating characteristic curve of 0.75 (95% CI, 0.66-0.85). There was no statistically significant association between IADE and lobar ICH (adjusted OR, 1.29 [95% CI, 0.36-4.64], P=0.70) or cerebral amyloid angiopathy (adjusted OR, 0.46 [95% CI, 0.13-1.67], P=0.24).

Conclusions: IADE is found in approximately 12% of patients with ICH and is independently associated with neuroimaging markers of arteriolosclerosis but not cerebral amyloid angiopathy.

Keywords: cerebral microbleed; dolichoectasia; intracerebral hemorrhage; lacune; small vessel disease; white matter hyperintensity.

背景：颅内动脉长扩张（IADE）与缺血性卒中人群中脑小血管病（CSVD）相关。然而，在患有自发性脑出血（ICH）的患者中，IADE是否与CSVD标志物有关尚不清楚，但可能对CSVD的诊断和预后有重要意义。我们的目的是调查ICH患者的IADE的患病率及其关联。

方法：我们纳入了2016年2月至2023年9月期间连续的ICH患者。使用基于验证量表评估血管直径、长度和迂曲度的磁共振血管造影来确定IADE。通过经过验证的磁共振成像评分量表调查CSVD的神经影像学标志物。左心室质量（LVM）通过经胸超声心动图测定。采用多变量二元逻辑回归分析评估IADE与CSVD之间的关联。

结果：我们纳入了138名平均年龄为66.7±11.8岁、男性比例为58.0%的患者。IADE出现在16名患者中（11.6%）。患有IADE的患者的LVM较大（183.0±61.3克 vs 155.3±51.2克，P=0.04）。ICH合并IADE的患者深部腔梗的比例显著高于无IADE者（43.8% vs 18.0%，P=0.02），深部脑微出血的比例也较高（56.3% vs 27.1%，P=0.02）。经过调整后，IADE独立与深部腔梗（校正后的比值比[OR]：3.10 [95% CI, 1.02-9.55], P=0.04）、严重脑室周围白质高信号（校正后的OR：3.29 [95% CI, 1.00-10.94], P=0.04）以及深部脑微出血（校正后的OR：2.80 [95% CI, 1.04-8.65], P=0.04）相关。在这些CSVD标志物中，IADE对预测深部脑微出血具有较高的预测价值，在接受者操作特征曲线下面积为0.75（95% CI, 0.66-0.85）。IADE与皮层下ICH或脑淀粉样血管病之间没有统计学上的显著关联。

结论：在大约12％的ICH患者中发现了IADE，并且它独立地与动脉粥样硬化的神经影像标志物相关，而不是与脑淀粉样血管病变有关。

关键词：脑微出血；长扩张；自发性脑内出血；腔隙；小血管病；白质高信号。