Mohammad Kassir, PGY4, R3 September 15th, 2016

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Presentation transcript:

Mohammad Kassir, PGY4, R3 September 15th, 2016 Measuring the Change in Size of Intracranial Hematomas on SWI After Administration of Normobaric Oxygen Mohammad Kassir, PGY4, R3 September 15th, 2016

Introduction: Intracranial hemorrhage is an important cause of morbidity and mortality in patients. Multiple pathological processes, such as trauma, stroke, neoplasm, and arteriovenous malformations. Susceptibility weighted imaging (SWI) MRI is a powerful tool for characterization of intracranial hemorrhage. Haacke et al., AJNR, 2009

Hyperventiliation Breath Hold Introduction: SWI exploits magnetic susceptibility differences between deoxygenated blood products and the surrounding brain tissue, resulting in prominent loss of signal in acute and early subacute blood. Recent research: change in blood oxygen levels secondary to apnea and hyperventilation can be detected on SWI. the administration of normobaric oxygen to acute unilateral middle cerebral artery ischemic stroke rat models led to a change in SWI signal in the penumbra and contralateral normal brain. Haacke et al. AJNR 2009; Chang et al. AJNR 2014; Zhou et al. SPIE Medical Imaging 2015

Intracerebral Hematomas Disappear on T2 Intracerebral Hematomas Disappear on T2*-Weighted Images During Normobaric Oxygen Therapy Time Room Air 15m O2 30m O2 45m O2 +1hr Room Air Gaberel et al. Stroke 2013 Experimentally induced intracerebral hemorrhage in mouse model. Significant decrease in apparent size of intracerebral hematoma under normobaric oxygen. Effect is reversible after 1 hr of normoxia.

Hypothesis Normobaric oxygen therapy affects the sensitivity of SWI for detecting intracerebral hemorrhagic lesions in human subjects.

Methods: Prospective trial Institutional Review Board # 5150422 Inclusion criteria: Adult inpatients at LLUMC, with known or suspected intracerebral hemorrhage, with an existing order for an MRI study of the brain. Exclusion criteria: Intubated patients, clinical contraindication to normobaric oxygen therapy, general contraindication to MRI.

Methods: 1st SWI Room Air O2 >30 min 2nd SWI MRI Department

Methods: Volume Quantification: Volume of hemorrhagic lesion measured for room air and post O2 SWI sequences using Spin 2010 software. Ratio of post O2 to room air volume of hemorrhage calculated.

Results: Age/Gender Etiology Location Baseline O2 FiO2 %100 Duration 56M Post operative left temporal mass Left temporal lobe Room Air 31 min 58M Lung cancer hemorrhagic mets Multiple bilateral 39 min 73F Post operative pituitary adenoma Pituitary fossa 45 min

Results: Room Air O2 Patient 1 Patient 2 Patient 3

Discussion: Preliminary conclusions: No qualitative difference in appearance of intracerebral hemorrhagic lesion between pre- and post- normobaric oxygen therapy SWI images. No significant difference in measured volume of intracerebral hemorrhagic lesion. The apparent size of intracerebral hemorrhagic lesions on SWI is not affected by patient oxygen therapy. The phenomenon demonstrated in experimentally induced intracerebral hematomas in mice is likely of no clinical significance to patients with acute or subacute intracranial hemorrhage. Limitations: Small sample size. Time on oxygen.

References: Haacke, E. Mark, et al. "Susceptibility-weighted imaging: technical aspects and clinical applications, part 1." American Journal of Neuroradiology 30.1 (2009): 19-30. Mittal, S., et al. "Susceptibility-weighted imaging: technical aspects and clinical applications, part 2." American Journal of Neuroradiology 30.2 (2009): 232-252. Gaberel, Thomas, et al. "Intracerebral hematomas disappear on T2*-weighted images during normobaric oxygen therapy." Stroke 44.12 (2013): 3482-3489. Chang, K., et al. "Imaging the effects of oxygen saturation changes in voluntary apnea and hyperventilation on susceptibility-weighted imaging." American Journal of Neuroradiology 35.6 (2014): 1091-1095. Zhou, Iris Y., et al. "Susceptibility weighted imaging of stroke brain in response to normobaric oxygen (NBO) therapy." SPIE Medical Imaging. International Society for Optics and Photonics, 2015.

Thanks PI: Dr. Sam Barnes Mentors: Dr. Karen Tong Dr. Paggie Kim