Diffusion Tensor Imaging Predicts Motor Functional Outcome after Acute Hypertensive Intracerebral Hemorrhage

Abstract OBJECTIVE We prospectively investigated the predictive value of diffusion tensor tractography for motor functional outcome in a case series of patients with intracerebral hemorrhage. METHODS Diffusion tensor tractography was performed in 17 patients with intracerebral hemorrhage (putamen, nine patients; thalamus, seven patients; combined, one patient) within 5 days after onset. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values along the corticospinal tracts at the level of the hematoma were measured bilaterally, and the ratios of values (hematoma side/contralateral side) were determined as FA and ADC ratios, respectively. Patients were evaluated for motor function on admission and at 3 months after onset using the manual muscle test score and then divided into good (manual muscle test, 4–5) and poor (manual muscle test, 0–3) motor function groups. RESULTS FA ratio measured shortly after the onset of intracerebral hemorrhage correlated well with motor functional outcome at 3 months (P < 0.05) but not with motor function on admission. FA ratios in the group with good motor functional outcome were significantly higher than those in the group with poor motor functional outcome (P < 0.01). The ADC ratio did not correlate with motor function either on admission or at 3 months. All patients with an FA ratio greater than 0.8 had a good motor functional outcome. In three patients, however, motor functional outcomes were favorable even though FA ratios were not high; in these patients, ADC ratios tended to be elevated. CONCLUSION Motor functional outcome in patients with intracerebral hemorrhage can be predicted by measuring FA values using diffusion tensor tractography.

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The role of preoperative diffusion tensor imaging in predicting and improving functional outcome in pediatric patients undergoing epilepsy surgery: a systematic review

BJR|Open ◽

10.1259/bjro.20200002 ◽

2021 ◽

Vol 3 (1) ◽

pp. 20200002

Author(s):

Jose Leon-Rojas ◽

Isabel Cornell ◽

Antonio Rojas-Garcia ◽

Felice D’Arco ◽

Jasmina Panovska-Griffiths ◽

...

Keyword(s):

Systematic Review ◽

Diffusion Tensor Imaging ◽

Functional Outcome ◽

Epilepsy Surgery ◽

Outcome Prediction ◽

Pediatric Patients ◽

Diffusion Tensor ◽

Pediatric Epilepsy ◽

Motor Outcome

Objective: Diffusion tensor imaging (DTI) is a useful neuroimaging technique for surgical planning in adult patients. However, no systematic review has been conducted to determine its utility for pre-operative analysis and planning of Pediatric Epilepsy surgery. We sought to determine the benefit of pre-operative DTI in predicting and improving neurological functional outcome after epilepsy surgery in children with intractable epilepsy. Methods: A systematic review of articles in English using PubMed, EMBASE and Scopus databases, from inception to January 10, 2020 was conducted. All studies that used DTI as either predictor or direct influencer of functional neurological outcome (motor, sensory, language and/or visual) in pediatric epilepsy surgical candidates were included. Data extraction was performed by two blinded reviewers. Risk of bias of each study was determined using the QUADAS 2 Scoring System. Results: 13 studies were included (6 case reports/series, 5 retrospective cohorts, and 2 prospective cohorts) with a total of 229 patients. Seven studies reported motor outcome; three reported motor outcome prediction with a sensitivity and specificity ranging from 80 to 85.7 and 69.6 to 100%, respectively; four studies reported visual outcome. In general, the use of DTI was associated with a high degree of favorable neurological outcomes after epilepsy surgery. Conclusion: Multiple studies show that DTI helps to create a tailored plan that results in improved functional outcome. However, more studies are required in order to fully assess its utility in pediatric patients. This is a desirable field of study because DTI offers a non-invasive technique more suitable for children. Advances in knowledge: This systematic review analyses, exclusively, studies of pediatric patients with drug-resistant epilepsy and provides an update of the evidence regarding the role of DTI, as part of the pre-operative armamentarium, in improving post-surgical neurological sequels and its potential for outcome prediction.

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