Abstract
White matter (WM) injury and survival after intracerebral hemorrhage (ICH) has received insufficient attention. WM disruption surrounding the hematoma has been documented in animal models with histology, but rarely in human ICH with noninvasive means, like magnetic resonance imaging (MRI). A few human MRI studies have investigated changes in long WM tracts after ICH remote from the hematoma, like the corticospinal tract, but have not attempted to obtain an unbiased quantification of WM changes within and around the hematoma over time. This study attempts such quantification from 3 to 30 days post ictus. Thirteen patients with mild to moderate ICH underwent diffusion tensor imaging (DTI) MRI at 3, 14, and 30 days. Fractional anisotropy (FA) maps were used to calculate the volume of tissue with FA > 0.5, both within the hematoma (lesion) and in the perilesional tissue. At day 3, the percentages of both lesional and perilesional tissue with an FA > 0.5 were significantly less than contralateral, unaffected, anatomically identical tissue. This perilesional contralateral difference persisted at day 14, but there was no significant difference at day 30. The loss of perilesional tissue with FA > 0.5 increased with increasing hematoma size at day 3 and day 14. All patients had some tissue within the lesion with FA > 0.5 at all time points. This did not decrease with duration after ictus, suggesting the persistence of white matter within the hematoma/lesion. These results outline an approach to quantify WM injury, both within and surrounding the hematoma, after mild to moderate ICH using DTI MRI. This may be important for monitoring treatment strategies, such as hematoma evacuation, and assessing efficacy noninvasively.
Highlights
Neural functional compromise post intracerebral hemorrhage (ICH) is devastating, as it leads to a nearly 40% 1 month mortality [1,2]
All recruited patients had hematomas located in the basal ganglia region, except for one patient who had a lobar hemorrhage with intraventricular hemorrhage (IVH)
The larger hematomas were associated with poor outcomes, with a modified Rankin Scale score of 4 in the patient with a 39 mL hematoma at 11 month follow-up
Summary
Neural functional compromise post intracerebral hemorrhage (ICH) is devastating, as it leads to a nearly 40% 1 month mortality [1,2]. Animal ICH models have implicated iron as a major mediator of neurotoxicity, specific pathways of injury to WM have not been fully elucidated [3,5]. Diffusion tensor imaging (DTI) has been used to examine ICH-induced injury to large WM fiber tracts, e.g., the corticospinal tract (CST) [6]. The application of DTI in ICH-related injury to WM fibers has, as yet, focused on assessing the correlation of long-term functional outcome with initial insult. Some animal ICH models have applied DTI to assess changes in CST following minimally invasive surgery (MIS) [7].
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