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Gray-to-white matter ratio predicts long-term recovery potential of patients with aneurysmal subarachnoid hemorrhage

Abstract

Predicting recovery potential of patients with aneurysmal subarachnoid hemorrhage (aSAH) is challenging. We investigated whether the gray-to-white matter ratio (GWR) predicts recovery of cognitive function (CF) and quality of life (QOL) of these patients. We analyzed data of 69 patients with aSAH. Patients’ demographics, comorbidities, and neurological status were recorded. One year after aSAH, Montreal Cognitive Assessment (MoCA) and Short Form-36 (SF-36) tests were administered to the patients, and brain volumes of patients were examined using MRI. Three years after aSAH, MoCA and SF-36 tests were conducted again. Differences between the test scores 1 and 3 years after aSAH were evaluated (ΔMoCA and ΔSF-36). Patients with ΔMoCA ≥ 4 points and those with ΔSF-36 ≥ 8 points were referred to as good MoCA and SF-36 recovery, respectively. ΔMoCA correlated with GWR in male and female patients (females: p < 0.001, R2 = 0.581; males: p < 0.001, R2 = 0.481). In female patients, GWR > 1.34 predicted good MoCA recovery with 82.3% sensitivity and 80% specificity, and in male patients, GWR > 1.36 predicted good MoCA recovery with 80% sensitivity and 95% specificity. ΔSF-36 correlated with GWR in male and female patients (females: p < 0.001, R2 = 0.479; males: p < 0.001, R2 = 0.627). In female patients, GWR > 1.35 predicted good SF-36 recovery with 74% sensitivity and 84% specificity, and in male patients, GWR > 1.38 predicted good SF-36 recovery with 72% sensitivity and 92% specificity. GWR is a good predictor of the recovery of CF and QOL in patients with aSAH and, thus, can help physicians to better organize rehabilitation of patients.

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Acknowledgments

Preparation for publication of this article was partly supported by the Turkish Neurosurgical Society.

Funding

Support was provided solely by institutional and/or departmental sources.

Author information

Correspondence to Achmet Ali.

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Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

The present study was approved by the Ethics Committee of the Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey (Ethics committee no. 2018/276).

Informed consent

Written informed consent was obtained from all patients and/or surrogates.

Electronic supplementary material

Supplementary image 1A
figure4

Belong to female 48 years aged patient. MRI was performed 3 years after aSAH. Basilar artery aneurysm treated by coiling. GWR value is 1.32 (good GWR value). ΔMoCA is 9 and ΔSF-36 is 10 1B: Belong to male 57 years aged patient. MRI was performed 2 years and 11 months after aSAH. Anterior communicating artery aneurysm treated by coiling. GWR value is 1.22 (low GWR). ΔMoCA is 3 and ΔSF-36 is 6 (PNG 347 kb)

High resolution image (TIF 8842 kb)

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Ali, A., Bitir, B., Abdullah, T. et al. Gray-to-white matter ratio predicts long-term recovery potential of patients with aneurysmal subarachnoid hemorrhage. Neurosurg Rev 43, 195–202 (2020). https://doi.org/10.1007/s10143-018-1029-y

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Keywords

  • Cerebral aneurysm
  • Subarachnoid hemorrhage
  • Cognitive function
  • Quality of life
  • Gray-to-white matter ratio