Abstract TMP82: Changes In DTI Metrics In The Lateral Ventricle Of Patients With Intraventricular Hemorrhage (IVH)

Abstract

Objective: To evaluate a non-invasive surrogate imaging marker for blood evacuation in patients with IVH. Clinical Relevance: Extension of intracerebral hemorrhage (ICH) to the ventricles increases the 48 hours mortality by 43%, requiring external ventricular drains (EVD) to mitigate hydrocephalus and monitor intracranial pressures. Blood increases CSF viscosity, altering the diffusion coefficient. We hypothesize change in lateral ventricle (LV) DTI metrics, fractional anisotropy (FA) and mean diffusivity (MD), can be used as a marker for blood removal after IVH. Methods: A sub-cohort of 20 patients in SHRINC trial with ICH and IVH were serially imaged at day 1 (T1=20), 14 (T1=20), 28 (T3=16), and 42 (T4=13) on a 3T MRI system. The serial T1w, segmented LV (JHU WM atlas) volumes, FA, and MD maps were registered. The FA and MD of ipsi and contralesional LV were recorded. Clinical assessment (NIHSS) was associated with the change in FA and MD of LV. A mixed model statistical analysis was performed. Results: We serially imaged 11M/9F with average age 55.4±8.7 years. The baseline hematoma volume and NIHSS were 22.1±18.5 cc and 16.1±8.7 respectively. The patients had basal ganglia (n=12) and thalamic (n=8) ICH extended into LV. The ipsilesional FA was significantly (T1=0.24, T4=0.15, p<0.001) decreased (1.17% /day), and MD was significantly (T1 = 1.49*10 -3 mm 2 /sec, T4 = 2.37 *10 -3 mm 2 /sec, p<0.001) increased (2.4 x 10 -5 mm 2 /sec/day). At T4, there was no relationship (p=0.919) between ipsilesional and contra-MD of LV (Fig-1). Patients with higher baseline NIHSS had a significant temporal decline in FA than those with lower NIHSS (p<0.05). Temporally, ipsilesional MD was negatively associated with the baseline NIHSS (p=0.039). Conclusion: The data suggest that DTI metrics of FA and MD are associated with blood clearance from the ipsilesional ventricle.