Objective:

To examine the relationship between cerebral small vessel disease (CSVD), intracranial arterial stenosis (ICAS), and diffusion-weighted imaging (DWI) lesions in patients with spontaneous intracerebral hemorrhage (ICH), highlighting the clinical significance of these associations.

Key Findings:

• 25.3% of patients presented with DWI lesions.
• Severe total CSVD burden significantly associated with DWI lesions (OR 3.56, 95% CI 2.22–5.72).
• A six-point modified CSVD score enhanced prediction of DWI lesions (OR 4.66, 95% CI 2.86–7.61).
• Moderate to severe ICAS was associated with DWI lesions (OR 2.27, 95% CI 1.39–3.77).
• The association between ICAS and DWI lesions was stronger when both ICAS and moderate total CSVD burden coexisted (OR 4.44, 95% CI 1.85–10.69).

Interpretation:

The study suggests that severe CSVD burden and moderate to severe ICAS are significant predictors of DWI lesions in ICH patients, indicating a potential combined effect of these conditions that may inform clinical management.

Limitations:

• Retrospective design may introduce selection bias, potentially affecting the validity of the findings.
• Single-center study limits generalizability to broader populations.
• Potential confounding factors not fully controlled may influence the observed associations.

Conclusion:

Severe CSVD burden and ICAS are associated with DWI lesions in ICH patients, with a compounded risk when both conditions are present, underscoring the need for integrated assessment in clinical practice.