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Published on: August 14, 2019
Acute corticospinal tract diffusion tensor imaging predicts 6-month functional outcome after intracerebral
G Schwarz1,2, B Kanber3,4,5, F Prados3,4,5,6
1Neurologia, Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Insights
Diffusion tensor imaging (DTI) of the corticospinal tract (CST) shows potential for predicting functional outcomes after intracerebral hemorrhage (ICH). DTI metrics, when combined with existing scores, may improve outcome prediction in ICH patients.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Diffusion tensor imaging (DTI) assesses corticospinal tract (CST) integrity in vivo.
- Intracerebral hemorrhage (ICH) can damage the CST, impacting functional outcomes.
- Predicting long-term functional recovery after ICH is crucial for patient management.
Purpose of the Study:
- To investigate the association between CST DTI metrics and 6-month functional outcomes after ICH.
- To determine if CST DTI metrics can enhance the predictive performance of the existing ICH score.
- To explore the utility of DTI in predicting recovery from deep supratentorial spontaneous ICH.
Main Methods:
- Retrospective analysis of 42 patients with DTI within 5 days of ICH.
- Calculation of ipsilesional-to-contralesional ratios for fractional anisotropy (rFA) and mean diffusivity (rMD) in the pontine segment (PS) of the CST.
- Utilized LASSO regression and AUC to identify predictive variables and assess model discrimination for 6-month mRS > 2.
Main Results:
- Lower rFA and higher rMD in the PS-CST were associated with poor 6-month functional outcome (mRS > 2).
- Individual DTI metrics (rFA, rMD) showed predictive ability comparable to the ICH score (AUCs 0.71-0.72 vs 0.76).
- Combined models incorporating DTI metrics improved predictive discrimination (AUC 0.82).
Conclusions:
- Pontine segment CST rFA and rMD metrics show promise in predicting 6-month functional outcome after ICH.
- Integrating DTI metrics into existing clinical-radiological scores may enhance prediction accuracy.
- Larger studies are needed to validate these findings and confirm the clinical utility of DTI in ICH prognostication.
Introduction:
Diffusion tensor imaging (DTI) can assess the structural integrity of the corticospinal tract (CST) in vivo. We aimed to investigate whether CST DTI metrics after intracerebral haemorrhage (ICH) are associated with 6-month functional outcome and can improve the predictive performance of the existing ICH score.
Methods:
We retrospectively included 42 patients with DTI performed within 5 days after deep supratentorial spontaneous ICH. Ipsilesional-to-contralesional ratios were calculated for fractional anisotropy (rFA) and mean diffusivity (rMD) in the pontine segment (PS) of the CST. We determined the most predictive variables for poor 6-month functional outcome [modified Rankin Scale (mRS) > 2] using the least absolute shrinkage and selection operator (LASSO) method. We calculated discrimination using optimism-adjusted estimation of the area under the curve (AUC).
Results:
Patients with 6-month mRS > 2 had lower rFA (0.945 [± 0.139] vs 1.045 [± 0.130]; OR 0.004 [95% CI 0.00-0.77]; p = 0.04) and higher rMD (1.233 [± 0.418] vs 0.963 [± 0.211]; OR 22.5 [95% CI 1.46-519.68]; p = 0.02). Discrimination (AUC) values were: 0.76 (95% CI 0.61-0.91) for the ICH score, 0.71 (95% CI 0.54-0.89) for rFA, and 0.72 (95% CI 0.61-0.91) for rMD. Combined models with DTI and non-DTI variables offer an improvement in discrimination: for the best model, the AUC was 0.82 ([95% CI 0.68-0.95]; p = 0.15).
Conclusion:
In our exploratory study, PS-CST rFA and rMD had comparable predictive ability to the ICH score for 6-month functional outcome. Adding DTI metrics to clinical-radiological scores might improve discrimination, but this needs to be investigated in larger studies.
