Original Article
Diffusion Tensor Imaging for Intracerebral Hemorrhage Outcome Prediction: Comparison Using Data from the Corona Radiata/Internal Capsule and the Cerebral Peduncle

https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.06.014Get rights and content

Background

Magnetic resonance–diffusion tensor imaging (DTI) was used to predict motor outcome for patients with intracerebral hemorrhage. We compared the predictive accuracy of data sampled from the cerebral peduncle with data from the corona radiata/internal capsule. This study included 32 subjects with thalamic or putaminal hemorrhage or both.

Methods

DTI data were obtained on days 14 to 18. Mean values of fractional anisotropy (FA) within the cerebral peduncle and the corona radiata/internal capsule were analyzed using a computer-automated method. Applying ordinal logistic regression analyses, the ratios between FA values in the affected and unaffected hemisphere (rFA) were modeled in relation to motor outcome scores at 1 month after onset, assessed using the Medical Research Council (MRC) scale (0 = null to 5 = full).

Results

For both cerebral peduncle and corona radiata/internal capsule, the relationships between rFA and MRC matched logistic probabilities. While cerebral peduncle rFA values had statistically significant relationships with MRC scores (upper extremity R2 = 0.271; lower extremity R2 = 0.191), rFA values for the corona radiata/internal capsule showed less significant relationships (upper extremity R2 = 0.085; lower extremity R2 = 0.080). When estimated cerebral peduncle rFA values were <0.7, estimated probability of MRC 0 to 2 was close to 85% for the upper and 60% for the lower extremities. Meanwhile, when estimated rFA values were >0.9, estimated probability for MRC 4 to 5 nearly equaled 50% for the upper and 60% for the lower extremities.

Conclusions

FA values from within the cerebral peduncle more accurately predicted motor outcome and is a promising technique for clinical application.

Section snippets

Patients

The study population was comprised of stroke patients with ICH who were admitted to our hospital between January 2010 and March 2011. These patients were transferred to our hospital soon after onset. Typically, these patients underwent conservative treatment such as medication to reduce hypertension and, for some, necessary surgical removal of hematoma. During hospitalization, they also underwent physical therapy, occupational therapy, and speech therapy for a combined daily total of up to 180

Results

Table 1 presents the profiles of 32 patients enrolled in this study. For these patients, rFA values ranged from 0.548 to 1.059 (median 0.848) for the cerebral peduncle and from 0.415 to 1.026 (median 0.732) for the corona radiata/internal capsule. Fig 2 shows typical brain images (CT and DTI-FA) from 5 patients (1, 8, 16, 24, and 32 in Table 1). Despite the variations in size and location of hematoma, DTI-FA brain images transformed into the standard space (Fig 1) were comparable across

Discussion

To develop a clinical useful method for motor outcome prediction, we have been applying newly developed MRI–DTI technology. Applying this technique, we investigated whether neural degeneration (rFA value) and in particular corticospinal tracts better predicts motor outcome. We found that FA values from the cerebral peduncle better predict motor outcome than values from the corona radiata/internal capsule.

Conclusion

Using computer-automated methodology, we successfully transformed the brain images of individual patients to the standard space. These DTI-FA images were comparable across patients, suggesting clinical applicability of this methodology. Using templates for corticospinal tracts located in the standard space, we compared the predictive accuracy of data from the corona radiata/internal capsule and the cerebral peduncle. Our analyses showed that FA values recorded in the cerebral peduncle better

Acknowledgment

The authors thank FMRIB Image Analysis Group, Oxford University for the FSL analysis software.

References (32)

  • T. Koyama et al.

    Motor outcome for patients with acute intracerebral hemorrhage predicted using diffusion tensor imaging: An application of ordinal logistic modeling

    J Stroke Cerebrovasc Dis

    (2011 Apr 19)
  • K. Yamada et al.

    Wallerian degeneration of the inferior cerebellar peduncle depicted by diffusion weighted imaging

    J Neurol Neurosurg Psychiatry

    (2003)
  • J.P. Broderick et al.

    Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality

    Stroke

    (1993)
  • R.U. Kothari et al.

    The ABCs of measuring intracerebral hemorrhage volumes

    Stroke

    (1996)
  • Image Analysis Group, Oxford, UK. FMRIB Software Library. Available from: http://www.fmrib.ox.ac.uk/fsl/. Accessed...
  • Image Analysis Group, Oxford, UK FMRIB’s Diffusion Toolbox - FDT v2.0. Available from:...
  • Cited by (0)

    Supported by the Medical Research Fund of the Hyogo Medical Association (MRF-H-06-10).

    View full text