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Abstract Details

Predicting Functional Outcomes Using Radiographic Characteristics of Spontaneous ICH-Mediated Encephalomalacia (IME) in the MISTIE-II Cohort
Cerebrovascular Disease and Interventional Neurology
S15 - Intracerebral Hemorrhage and SAH (2:17 PM-2:28 PM)
008
Hemorrhagic stroke represents 15% of stroke and portends disproportionately poor outcomes for patients. Encephalomalacia following spontaneous intracerebral hemorrhage (ICH) is a common radiological finding on follow-up neuroimaging. Currently, there is no substantive research investigating the associative nature between radiographic characteristics of ICH-Mediated Encephalomalacia (IME), clinical variables, and functional outcome data.

To quantitatively characterize the radiologic presentation of ICH-Mediated Encephalomalacia on Day 180 CTs and assess its’ relationship to clinical variables and Day 180 functional outcomes following hemorrhagic stroke in patients enrolled in the MISTIE-II trial.

MISTIE-II patients with Day 180 CTs were included (n=46). Volume segmentation was performed by 1 expert reader (HA) using a free-handed technique within the image-processing software OsiriXMD (Pixmeo). Imaging-based measurements included volume and average HU values for IME (lesion site CSF-like hypointensity), and ‘Effected’ Region' (lesion site and adjacent hypoattenuated tissue). ICH/IVH volumes were obtained with a semi-automated planimetry approach. Regression analysis defined “good” functional outcome at D180 as an mRS 0-3.

Patients with poor Day 180 functional outcomes had larger Relative IME Volumes [(IME Vol)/(Stability ICH Vol)]; 0.52-0.32 cc p=0.02), lower average IME HU values (13.3-15.8 HU p=0.02), and marginally larger IME volumes (19.4-14.3 cc, p=0.12). Univariate and multivariate logistic regression predicted a 4% and 6% decrease in the odds of good functional outcome for each unit increase in Relative IME Volume, respectively (p=0.013; p=0.025).Patients with lobar hemorrhages displayed larger ER volumes (30.0-18.9 cc, p=0.05) and near larger IME volumes (21.2-14.0 cc, p=0.06) than deep hemorrhages. Random sampling for reproducibility yielded no significant difference between expert and comparator (AG) IME/ER volumes (p=0.41).

Our results suggest Relative IME Volume to be a potentially meaningful and novel predictor of poor functional outcome after stroke. There exist clinical correlates to IME volume and further research regarding mechanisms driving accelerated or attenuated IME growth after stroke is needed.

Authors/Disclosures
Hasan Ali
PRESENTER
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Daniel F. Hanley, MD, FAAN (Johns Hopkins Medicine, Acute Care Neurology) Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurotrope. Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. The institution of Dr. Hanley has received research support from NIH/NCATS. The institution of Dr. Hanley has received research support from NIH/NINDS.