Journal
JOURNAL OF NEUROLOGY
Volume 269, Issue 11, Pages 6058-6066Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00415-022-11245-1
Keywords
Deep intracerebral haemorrhage; Outcome prediction; Fractional anisotropy; Mean diffusivity; ICH score; Corticospinal tract
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Funding
- Department of Health's National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme
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This study aimed to investigate the association between CST DTI metrics after ICH and 6-month functional outcome, as well as the potential improvement in predictive performance of the existing ICH score. The results showed that rFA and rMD were associated with 6-month mRS>2, and discrimination values varied among different variables. Combined models with DTI and non-DTI variables offered an improvement in discrimination.
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.
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