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Prognostic Value of a Structural Brain MRI Score in the Acute Phase of Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

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Abstract

Background/Objective

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality despite advances in management. We evaluated the prognostic significance of a qualitative score using brain magnetic resonance imaging (MRI) features obtained early after aSAH.

Methods

Patients with aSAH were enrolled in a prospective observational cohort and underwent brain MRI during their acute hospitalization. MRIs were rated using a scoring system that considers the anatomical location of signal intensity changes on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences. The relationship between MRI scores and functional outcome defined by modified Rankin scale (mRS) at 6 months was evaluated in uni- and multivariable models.

Results

The cohort included 45 aSAH patients (median World Federation of Neurologic Surgeons (IQR) 2 (1–4)) who underwent brain MRI a mean (SD) of 9.0 ± 8.0 days after aSAH. At 6 months after aSAH, 26 patients had achieved a favorable outcome (mRS ≤ 2) while 15 had an unfavorable outcome (mRS > 2). Deep gray nuclei (DGN) score (p = 0.016), cortex + DGN score (p = 0.015), FLAIR score (p = 0.016), DWI score (p = 0.0045), and overall score (p = 0.0081) were significantly lower in patients with favorable outcome compared to those with unfavorable outcome. However, MRI scores were not independent predictors of outcome in multivariable models adjusting for admission Hunt and Hess, Glasgow Coma Scale, or World Federation of Neurologic Surgeons scales.

Conclusions

In this pilot study, a qualitative scoring system using anatomically defined MRI FLAIR and DWI signal abnormalities identified in the acute phase of aSAH was linked to 6-month functional outcome. However, these scores did not add prognostic value to established indices of neurological severity.

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Acknowledgements

We thank the patients and their families as well as the clinical staff who contributed to this study. Further, we acknowledge the valuable insights provided by Dr. Peter van Zijl (Chief, Neuroscience, Division of MR Research, Department of Radiology and Radiological Science).

Funding

Funding sources permitting performance of this work included grants from the Brain Aneurysm Foundation and from a Johns Hopkins Anesthesiology & Critical Care Medicine Stimulating and Advancing ACCM Research (StAAR) Award.

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Authors and Affiliations

  1. Department of Neurosurgery and Neurology, Mount Sinai West, 1000 10th Avenue, New York, NY, 10019, USA

    Sarah E. Nelson

  2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

    Pirouz Piran

  3. Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA

    Jun Hua, Haris I. Sair & Robert D. Stevens

  4. F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA

    Jun Hua & Robert D. Stevens

  5. Department of Neurosciences, Johns Hopkins University, Baltimore, MD, USA

    Alexander Sigmon

  6. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA

    Casey Weiner

  7. Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

    Jose I. Suarez & Robert D. Stevens

Authors
  1. Sarah E. Nelson
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  2. Pirouz Piran
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  3. Jun Hua
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  4. Alexander Sigmon
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  5. Casey Weiner
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  6. Haris I. Sair
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  7. Jose I. Suarez
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  8. Robert D. Stevens
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Contributions

SEN: Study design, data abstraction and analysis, critically revised manuscript. PP: Data abstraction, critically revised manuscript. JH and HIS: Study design, critically revised manuscript. AS: Data abstraction. CW: Critically revised manuscript. JIS: Study design, critically revised manuscript. RDS: Study design, data analysis, critically revised manuscript.

Corresponding author

Correspondence to Sarah E. Nelson.

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Conflicts of interest

S.E.N. Brain Aneurysm Foundation grant, Johns Hopkins Anesthesiology & Critical Care Medicine Stimulating and Advancing ACCM Research (StAAR) Award, Springer Nature and Boston Scientific personal fees. P.P. no disclosures. J.H. no disclosures. A.S. no disclosures. C.W. no disclosures. H.I.S. no disclosures. J.I.S. PCORI, NINDS/NIH. R.D.S. NIH//NHBLI, Johns Hopkins Discovery Award, Johns Hopkins Anesthesiology & Critical Care Medicine Stimulating and Advancing ACCM Research (StAAR) Award.

Ethical Approval/Informed Consent

This work was carried out with approval from the Johns Hopkins Institutional Review Board under two different protocols, and as such written informed consent was required for some but not all patients.

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Nelson, S.E., Piran, P., Hua, J. et al. Prognostic Value of a Structural Brain MRI Score in the Acute Phase of Aneurysmal Subarachnoid Hemorrhage: A Pilot Study. Neurocrit Care 35, 501–505 (2021). https://doi.org/10.1007/s12028-021-01209-0

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  • DOI: https://doi.org/10.1007/s12028-021-01209-0

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