Clinical implications of Peri-hematomal edema microperfusion fraction in intracerebral hemorrhage intravoxel incoherent motion imaging - A pilot study.

Background and Purpose: Perihematomal edema (PHE) represents the secondary brain injury after intracerebral hemorrhage (ICH). However, neurobiological characteristics of post-ICH parenchymal injury other than PHE volume have not been fully characterized. Using intravoxel incoherent motion imaging (IVIM), we explored the clinical correlates of PHE diffusion and (micro)perfusion metrics in subacute ICH.
Materials and Methods: In 41 consecutive patients scanned 1-to-7 days after supratentorial ICH, we determined the mean diffusion (D), pseudo-diffusion (D*), and perfusion fraction (F) within manually segmented PHE. Using univariable and multivariable statistics, we evaluated the relationship of these IVIM metrics with 3-month outcome based on the modified Rankin Scale (mRS).
Results: In our cohort, the average (± standard deviation) age of patients was 68.6±15.6 years, median (interquartile) baseline National Institute of Health Stroke Scale (NIHSS) was 7 (3-13), 11 (27 %) patients had poor outcomes (mRS>3), and 4 (10 %) deceased during the follow-up period. In univariable analyses, admission NIHSS (p < 0.001), ICH volume (p = 0.019), ICH+PHE volume (p = 0.016), and average F of the PHE (p = 0.005) had significant correlation with 3-month mRS. In multivariable model, the admission NIHSS (p = 0.006) and average F perfusion fraction of the PHE (p = 0.003) were predictors of 3-month mRS.
Conclusion: The IVIM perfusion fraction (F) maps represent the blood flow within microvasculature. Our pilot study shows that higher PHE microperfusion in subacute ICH is associated with worse outcomes. Once validated in larger cohorts, IVIM metrics may provide insight into neurobiology of post-ICH secondary brain injury and identify at-risk patients who may benefit from neuroprotective therapy.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Seyedmehdi Payabvash reports a relationship with National Institutes of Health that includes: funding grants. Seyedmehdi Payabvash reports a relationship with Doris Duke Charitable Foundation that includes: funding grants. Seyedmehdi Payabvash reports a relationship with Foundation of the American Society of Neuroradiology that includes: funding grants. Emily J Gilmore reports a relationship with National Institutes of Health that includes: funding grants. Emily J Gilmore reports a relationship with UCB that includes: consulting or advisory. Emily J Gilmore reports a relationship with Intracranial Bioanalytics that includes: non-financial support. Guido J. Falcone reports a relationship with National Institutes of Health that includes: funding grants. Guido J. Falcone reports a relationship with Neurocritical Care Society that includes: funding grants. Guido J. Falcone reports a relationship with Yale Pepper Scholar Award that includes: funding grants. Guido J. Falcone reports a relationship with American Heart Association that includes: funding grants. Kevin N. Sheth reports a relationship with National Institutes of Health that includes: funding grants. Kevin N. Sheth reports a relationship with American Heart Association that includes: funding grants. Kevin N. Sheth reports a relationship with Hyperfine Research Inc that includes: funding grants. Adam de Havenon reports a relationship with National Institutes of Health that includes: funding grants. Adam de Havenon reports a relationship with American Academy of Neurology that includes: funding grants. Adam de Havenon reports a relationship with Novo Nordisk that includes: consulting or advisory. Adam de Havenon reports a relationship with Integra that includes: consulting or advisory. Adam de Havenon reports a relationship with Titin KM that includes: equity or stocks. Adam de Havenon reports a relationship with UpToDate that includes: paid expert testimony.
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