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Abstract
Background We hypothesize that fractional anisotropy (FA) of the Ascending Reticular Activating System (ARAS) can be used to predict the state of consciousness of patients suffering intracerebral hemorrhage. To test this hypothesis, we performed a pilot analysis of the ARAS correlating NIH Stroke Score with quantitative assessment of the ARAS on DTI imaging.
Methods 21 patients with spontaneous ICH admitted to the Mount Sinai Health System between October 2017 and February 2018 were evaluated with NIHSS and MRI-DTI at 24–48 hours and 7–10 days using a 1.5 T scanner. DTI and tractography were performed with the READY view software, quantifying mean FA (mFA) and density with a ROI in the ventromedial mesencephalon. We divided patients into 2 subgroups: ‘conscious’ (NIHSS=0–15) and ‘unconscious’ (NIHSS=16–42).
Results Pearson’s correlation coefficient demonstrated that quantitative DTI metrics (mFA and density) negatively correlate with the NIHSS at 7–10 days. The biserial correlation test demonstrated a significant association between mFA and NIHSS subgroups at 7–10 days. We assessed the probability for each patient of being in the subgroups given mFA using multivariate logistic regression model. Using a decision tree analysis, the mFA cut-off threshold between the two subgroups is 0.3765 (sensitivity 93.3%, specificity 83.3%, ROC AUC=0.86).
Conclusions The mFA measured by quantitative DTI at 7–10 days after onset of intracerebral hemorrhage strongly predicts NIHSS. Patients with lower mFA values in the ARAS are far more likely to be unconscious.
Disclosures J. Scaggiante: None. N. Dangayach: None. X. Zhang: None. J. Mocco: 2; C; Rebound Therapeutics, Consulting Agreement, Consultant, Synchron, Consultant, Cerebrotech, Consulting Agreement, Consultant. 4; C; Synchron, Ownership Interest (Stock, options, shareholder), NeuroTechnology Investors, Ownership Interest (Stock, options, shareholder), The Stroke Project, Ownership Interest (Stock, options, shareholder), Endostream, Ownership Interest (Stock, options, shareholder), Apama, Ownership Interest (Stock, options, shareholder), NeurVana, Ownership Interest (Stock, options, shareholder). D. Lefton: None. C. Kellner: 2; C; Penumbra, Inc, Consulting Agreement.