Abstract Body: Introduction

A recent randomized-controlled trial confirmed the value of minimally-invasive intracerebral hemorrhage (ICH) evacuation to improve outcomes in properly-selected patients. Yet, there remains a need to optimize patient selection and prognosis following ICH evacuation. Magnetic resonance diffusion tensor imaging (DTI) allows visualization and quantification of critical white matter tracts. Corticospinal tract DTI (CST-DTI) in particular can be associated with motor function, which may improve prognosis and patient selection for ICH evacuation.

Methods

Patients who underwent minimally-invasive ICH evacuation and had perioperative DTI performed were retrospectively reviewed. CST metrics including fractional anisotropy, radial diffusivity, axial diffusivity, geodesic anisotropy, fiber count, and tract volume were associated with motor function pre- and postoperatively. Motor function was scored on each hemibody via the weakest muscle group in each extremity according to the Medical Research Council grading scale (maximum score of 10 on each hemibody).

Results

Eighteen patients with available peri-operative DTI data were included, 12 each with preoperative and postoperative DTI, seven with matched pre- and postoperative DTI. Preoperative geodesic anisotropy was significantly associated with both preoperative motor function on the contralateral hemibody (R=0.616, p=0.032, Pearson correlation) and at postoperative day one (R=0.606, p=0.038). Restoration of a deformed CST could be seen in several patients from preoperative to the immediate postoperative period (Figure 1). However, no preoperative or postoperative CST-DTI metrics were associated with motor scores at a median follow-up of 6.3 months post-ICH (p>0.05 for all comparisons). There was a significant increase in motor scores on the affected hemibody from postoperative day one to last follow-up (3.8±3.5 vs 6.3±6.8; p = 0.038, Wilcox signed-rank test).

Conclusions

Preoperative CST-DTI metrics are associated with both preoperative and immediate postoperative motor function after minimally invasive ICH evacuation. A restored CST after ICH evacuation could be seen in a subset of patients. However, neither preoperative nor immediate postoperative CST-DTI metrics were associated with longer-term motor function. Tractography from the perioperative period should be used with caution in providing motor prognosis.