Abstract Details

Title Atlas-Based Quantitative Diffusion-Weighted Mapping in Patients with Aneurysmal Subarachnoid Hemorrhage

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P06 - (-)

Poster/Presentation
Number 231

Objective

Background BACKGROUND: Parcellation of ADC maps demonstrates a regional pattern of diffusion restriction which has been associated with outcome following anoxic brain injury. We explored the value of this approach in patients with SAH.

Design/Methods DESIGN/METHODS: Patients underwent diffusion weighted brain MRI within 30 days of SAH. Atlas coregistration was performed using large deformation diffeomorphic metric mapping (LDDMM), and mean ADC values (in 10-6 mm2/s) were calculated in 26 regions of interest. Primary endpoint was Glasgow Outcome Scale (GOS) at hospital discharge or at 30 days.

Results RESULTS: We enrolled 59 patients: 43 women, mean age 51 years, median admission WFNS 3. Forty-two patients underwent aneurysm clipping, 14 had coiling. In patients who were non-comatose on admission (Glasgow Coma Scale >/= 9), ADC was significantly higher in the right hemisphere, right lobar grey matter and cerebellar white matter. Patients with unfavorable outcome (GOS 1,2 or 3) had significantly lower ADC than favorable outcome patients (GOS 4 or 5) in the following regions: right anterior limbic cortex (823 +/- 79 vs 910 +/- 159, p = 0.037), left corona radiata (816 +/- 92 vs 906 +/- 165, p = 0.039), left corpus callosum (973.5 +/- 124 vs 1114 +/- 242, p = 0.027), left basal ganglia (862 +/- 60 vs 951 +/- 161, p = 0.031), right basal ganglia (883 +/- 109 vs 1014 +/- 174, p = 0.006), and midbrain (867 +/- 136 vs 993 +/- 204, p = 0.023).

Conclusions CONCLUSIONS: Here, using clinically obtained MRI scans, we identified specific anatomical patterns of ADC which were linked with SAH severity and its short term outcome. These results underscore the value of atlas-based quantitative mapping in acute neurological injury.

Authors/Disclosures
Atul Kalanuria, MD (The Hospital of The University of Pennsylvania) PRESENTER	Dr. Kalanuria has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for American Medical Experts. Dr. Kalanuria has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Expertiq.
Richard Leigh, MD (Johns Hopkins University)	The institution of Dr. Leigh has received research support from National Institutes of Health. The institution of Dr. Leigh has received research support from American Heart Association. Dr. Leigh has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Ludwig Kappos, MD, FAAN (RC2NB, University Hospital Basel)	Dr. Kappos has nothing to disclose.
Robert Stevens (Johns Hopkins University)	No disclosure on file

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