Whole-brain diffusion tensor imaging predicts 6-month functional outcome in acute intracerebral haemorrhage

G Schwarz; B Kanber; F Prados; S Browning; R Simister; H R Jäger; G Ambler; C A M Gandini Wheeler-Kingshott; D J Werring; SIGNAL Investigators

doi:10.1007/s00415-023-11592-7

Whole-brain diffusion tensor imaging predicts 6-month functional outcome in acute intracerebral haemorrhage

J Neurol. 2023 May;270(5):2640-2648. doi: 10.1007/s00415-023-11592-7. Epub 2023 Feb 19.

Authors

G Schwarz^{1

2}, B Kanber^{3

4

5}, F Prados^{3

4

5

6}, S Browning², R Simister², H R Jäger⁷, G Ambler⁸, C A M Gandini Wheeler-Kingshott^{3

9

10}, D J Werring¹¹; SIGNAL Investigators

Affiliations

¹ Neurologia-Stroke Unit ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
² Stroke Research Centre, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, and National Hospital for Neurology and Neurosurgery, London, UK.
³ NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK.
⁴ Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, UCL, London, UK.
⁵ National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.
⁶ E-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain.
⁷ Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.
⁸ Department of Statistical Science, University College London, Gower Street, London, UK.
⁹ Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
¹⁰ Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy.
¹¹ Stroke Research Centre, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, and National Hospital for Neurology and Neurosurgery, London, UK. d.werring@ucl.ac.uk.

Abstract

Introduction: Small vessel disease (SVD) causes most spontaneous intracerebral haemorrhage (ICH) and is associated with widespread microstructural brain tissue disruption, which can be quantified via diffusion tensor imaging (DTI) metrics: mean diffusivity (MD) and fractional anisotropy (FA). Little is known about the impact of whole-brain microstructural alterations after SVD-related ICH. We aimed to investigate: (1) association between whole-brain DTI metrics and functional outcome after ICH; and (2) predictive ability of these metrics compared to the pre-existing ICH score.

Methods: Sixty-eight patients (38.2% lobar) were retrospectively included. We assessed whole-brain DTI metrics (obtained within 5 days after ICH) in cortical and deep grey matter and white matter. We used univariable logistic regression to assess the associations between DTI and clinical-radiological variables and poor outcome (modified Rankin Scale > 2). We determined the optimal predictive variables (via LASSO estimation) in: model 1 (DTI variables only), model 2 (DTI plus non-DTI variables), model 3 (DTI plus ICH score). Optimism-adjusted C-statistics were calculated for each model and compared (likelihood ratio test) against the ICH score.

Results: Deep grey matter MD (OR 1.04 [95% CI 1.01-1.07], p = 0.010) and white matter MD (OR 1.11 [95% CI 1.01-1.23], p = 0.044) were associated (univariate analysis) with poor outcome. Discrimination values for model 1 (0.67 [95% CI 0.52-0.83]), model 2 (0.71 [95% CI 0.57-0.85) and model 3 (0.66 [95% CI 0.52-0.82]) were all significantly higher than the ICH score (0.62 [95% CI 0.49-0.75]).

Conclusion: Our exploratory study suggests that whole-brain microstructural disruption measured by DTI is associated with poor 6-month functional outcome after SVD-related ICH. Whole-brain DTI metrics performed better at predicting recovery than the existing ICH score.

Keywords: Fractional anisotropy; ICH score; Intracerebral haemorrhage; Mean diffusivity; Outcome prediction; Whole-brain approach.

MeSH terms

Aged
Brain* / diagnostic imaging
Cerebral Hemorrhage* / diagnostic imaging
Diffusion Tensor Imaging* / methods
Female
Humans
Male
Middle Aged