White Matter Survival within and around the Hematoma: Quantification by MRI in Patients with Intracerebral Hemorrhage

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.

Minimally-invasive bedside catheter haematoma aspiration followed by local thrombolysis in spontaneous supratentorial intracerebral haemorrhage: a retrospective single-center study

“…To avoid such secondary injuries, several minimally-invasive procedures have subsequently been developed, with encouraging results ( 4 , 8 , 9 ). Recently, the critical view on surgical interventions has been reinforced by evidence of surviving white matter fibers within the hematoma that could be damaged by surgical interventions, which in turn may negatively impact self repair mechanisms and thereby functional outcome ( 22 , 23 ).…”

“…Surely, the technique is open for further improvement, for example a more specific and elaborated planning of the trajectory by using DTI to determine – and thereby sparing –the white matter tracts [as, e.g., reported by Du et al, Steineke and Barbery and Zhang et al ( 44 – 46 )] and also predict clinical outcome ( 47 , 48 ). Additionally, the supplement of tractography could be used to further evaluate the presence and role of surviving white matter tracts within the hematoma that are thought to be at risk for damage by the surgical intervention ( 22 , 23 ). However, the time delay to be expected as a result of performing tractography [median time to surgery reported by Zhang et al: 21 h ( 46 )] should not be lost sight of, since the recently reported more pronounced benefit of hematoma evacuation when MIS was performed earlier ( 11 ).…”