Clinical outcome in nontraumatic subarachnoid hemorrhage (SAH) is multifactorial and difficult to predict. Diffusion tensor imaging (DTI) findings are a prognostic marker in some diseases such as traumatic brain injury. The authors hypothesized that DTI parameters measured in the subacute phase of SAH can be associated with a poor clinical outcome.
Diffusion tensor imaging was prospectively performed in 54 patients at 8–10 days after nontraumatic SAH. Logistic regression analysis was performed to evaluate the association of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values with a poor clinical outcome (modified Rankin Scale score ≥ 3) at 3 months.
At 8–10 days post-SAH, after adjusting for other variables associated with a poor outcome, an increased ADC at the frontal centrum semiovale was associated with a poor prognosis (OR estimate 1.29, 95% CI 1.04–1.60, p = 0.020). Moreover, an increase of 0.1 in the FA value at the corpus callosum at 8–10 days after SAH corresponded to 66% lower odds of having a poor outcome (p = 0.002).
Decreased FA and increased ADC values in specific brain regions were independently associated with a poor clinical outcome after SAH. This preliminary exploratory study supports a potential role for DTI in predicting the outcome of SAH.
ABBREVIATIONSADC = apparent diffusion coefficient; AUC = area under the ROC curve; DCI = delayed cerebral ischemia; DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; FA = fractional anisotropy; GCS = Glasgow Coma Scale; HH = Hunt and Hess; MRI = magnetic resonance imaging; mRS = modified Rankin Scale; PLIC = posterior limb of internal capsule; ROC = receiver operating characteristic; ROI = region of interest; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies.
BranderAKatajaASaastamoinenARyyminPHuhtalaHOhmanJ: Diffusion tensor imaging of the brain in a healthy adult population: Normative values and measurement reproducibility at 3 T and 1.5 T. Acta Radiol51:800–8072010
De MarchisGMFilippiCGGuoXPuginDGaffneyCDDangayachNS: Brain injury visible on early MRI after subarachnoid hemorrhage might predict neurological impairment and functional outcome. Neurocrit Care22:74–812015
FronteraJAAhmedWZachVJovineMTanenbaumLSehbaF: Acute ischaemia after subarachnoid haemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study. J Neurol Neurosurg Psychiatry86:71–782015
JellisonBJFieldASMedowJLazarMSalamatMSAlexanderAL: Diffusion tensor imaging of cerebral white matter: a pictorial review of physics, fiber tract anatomy, and tumor imaging patterns. AJNR Am J Neuroradiol25:356–3692004
LiuYSoppiVMustonenTKönönenMKoivistoTKoskelaA: Subarachnoid hemorrhage in the subacute stage: elevated apparent diffusion coefficient in normal-appearing brain tissue after treatment. Radiology242:518–5252007
SenerSVan HeckeWFeyenBFEVan der SteenGPullensPVan de HauweL: Diffusion tensor imaging: a possible biomarker in severe traumatic brain injury and aneurysmal subarachnoid hemorrhage?Neurosurgery79:786–7932016
VergouwenMDIVermeulenMvan GijnJRinkelGJWijdicksEFMuizelaarJP: Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke41:2391–23952010