OBJECTIVEClinical outcome in nontraumatic subarachnoid hemorrhage (SAH) is multifactorial and difficult to predict. Diffusion tensor imaging (DTI) findings are a prognostic marker in some diseases such as traumatic brain injury. The authors hypothesized that DTI parameters measured in the subacute phase of SAH can be associated with a poor clinical outcome.METHODSDiffusion tensor imaging was prospectively performed in 54 patients at 8-10 days after nontraumatic SAH. Logistic regression analysis was performed to evaluate the association of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values with a poor clinical outcome (modified Rankin Scale score ≥ 3) at 3 months.RESULTSAt 8-10 days post-SAH, after adjusting for other variables associated with a poor outcome, an increased ADC at the frontal centrum semiovale was associated with a poor prognosis (OR estimate 1.29, 95% CI 1.04-1.60, p = 0.020). Moreover, an increase of 0.1 in the FA value at the corpus callosum at 8-10 days after SAH corresponded to 66% lower odds of having a poor outcome (p = 0.002).CONCLUSIONSDecreased FA and increased ADC values in specific brain regions were independently associated with a poor clinical outcome after SAH. This preliminary exploratory study supports a potential role for DTI in predicting the outcome of SAH.
Keywords: ADC = apparent diffusion coefficient; AUC = area under the ROC curve; DCI = delayed cerebral ischemia; DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; FA = fractional anisotropy; GCS = Glasgow Coma Scale; HH = Hunt and Hess; MRI = magnetic resonance imaging; PLIC = posterior limb of internal capsule; ROC = receiver operating characteristic; ROI = region of interest; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies; clinical outcome; diffusion tensor imaging; mRS = modified Rankin Scale; subarachnoid hemorrhage; vascular disorders.