Quantitative Corticospinal Tract Assessment in Acute Intracerebral Hemorrhage

Abstract

Intracerebral hemorrhage (ICH) prognostication during the acute phase is often subjective among physicians and often affects treatment decisions. The present study explores objective imaging parameters using quantitative corticospinal tract (CST) fiber reconstruction during the acute phase of ICH and correlates these parameters with functional outcome and patient recovery. We prospectively enrolled nonsurgical spontaneous supratentorial ICH patients and obtained an MRI scan on day 5 ± 1. Q-space diffeomorphic reconstruction was performed using DSI Studio, and quantitative anisotropy (QA) was calculated. The CST was reconstructed based on QA. The dichotomized modified Rankin Scale score on day 90 (favorable outcome = 0–2) and Barthel Index (favorable recovery = 100 on day 90 or improvement between discharge and day 90 > 60%) were assessed. Thirty-three patients, median age 72 years (interquartile range (IQR) 64–83), 21 female (64%), 21 (64%) with lobar hemorrhage, median ICH volume on admission 15.0 (IQR 7.0–27.4) mL, were included. Sixteen patients (48%) had a favorable outcome and 24 (73%) had a favorable recovery. The mean number of ipsilesional reconstructed CST fiber pathways was higher in patients with favorable outcomes (153 (standard deviation (SD) 103) vs. 60 (SD 39), p = 0.003) and predicted outcome after adjustment (Exp(B) = 1.016 (95% CI = 1.002–1.030)). QA in the ipsilesional posterior limb of the internal capsule showed a trend towards an association with favorable outcome (Exp(B) = 1.194 (95% CI = 0.991–1.439 (adjusted))). The total (ipsilesional + contralesional) number of reconstructed fiber pathways was associated with favorable recovery (Exp(B) = 1.025 (95% CI = 1.003–1.047 (adjusted))). Quantitative tractography parameters assessed in the acute phase of ICH may represent a promising predictor of long-term outcome and recovery. This might facilitate prognostic evaluation and organization of rehabilitation.

Oxymatrine ameliorates white matter injury by modulating gut microbiota after intracerebral hemorrhage in mice

“… 27 Quantitative tractography revealed that there were more reconstructed CST fiber pathways in ICH patients with favorable outcomes. 28 Based on the results above, treatment with OMT significantly alleviated ICH‐induced CST axon injury and demyelination at cervical enlargement, which is perhaps due to the protection of OMT against WMI in the primary lesion, or its inhibition of astrocytes/microglia activation and inflammatory response. Prolonged activation of microglia induced by myelin debris has long been implicated in aggravating inflammatory action by secreting pro‐inflammatory cytokines.…”

“…In stroke patients, the integrity of the CST was a determining factor for the proportional recovery of motor impairment [38]. Quantitative tractography revealed that there were more reconstructed CST ber pathways in ICH patients with favorable outcomes [39]. Our study revealed that treatment with OMT signi cantly alleviated ICH-induced CST axon injury and demyelination at cervical enlargement, which is perhaps due to the protection of OMT against WMI in the primary lesion, or it's inhibition of astrocytes/microglia activation and in ammatory response.. Additionally, detecting the immunophenotype of glial cells, we found that ICH activated more microglia and more astrocytes colabeled with GFAP and CSPG in the CST region of the cervical enlargement, suggesting that ICH caused CST destruction in the cervical enlargement, which subsequently induced microglia and astrocytes activation, while OMT signi cantly inhibited their activation and in ammatory response in the CST after ICH.…”

“…In stroke patients, the integrity of the CST was a determining factor for the proportional recovery of motor impairment 27 . Quantitative tractography revealed that there were more reconstructed CST fiber pathways in ICH patients with favorable outcomes 28 . Based on the results above, treatment with OMT significantly alleviated ICH‐induced CST axon injury and demyelination at cervical enlargement, which is perhaps due to the protection of OMT against WMI in the primary lesion, or its inhibition of astrocytes/microglia activation and inflammatory response.…”

Editorial for: “ΔADC Analysis of the Brain in Idiopathic Normal Pressure Hydrocephalus Before and After Cerebrospinal Fluid Drainage”

“…To optimize the prognostic accuracy as well as the choice of appropriate treatment for patients with idiopathic normal pressure hydrocephalus, a valid imaging biomarker for beneficial shunt surgery would be highly desirable. A wide variety of predictive imaging biomarkers has been reported, such as the penumbra in stroke, 3 diffusion metrics in intracerebral haemorrhage 4 and traumatic brain injury 5 , or tumor grading with magnetic resonance spectroscopy (MRS) 6 and chemical exchange saturation transfer (CEST) imaging 7 . This shows that by the use of advanced imaging methods, information on disease status and outcome can be obtained more and more noninvasively.…”