1. 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

2. 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

3. 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

4. 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.

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

6. 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.

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

8. 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.

9. 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

10. Results:
Room Air O2
Patient 1
Patient 2
Patient 3

11. 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.

12. References:
Haacke, E. Mark, et al. "Susceptibility-weighted imaging: technical aspects and clinical applications, part 1." American Journal of Neuroradiology 30.1 (2009):
Mittal, S., et al. "Susceptibility-weighted imaging: technical aspects and clinical applications, part 2." American Journal of Neuroradiology 30.2 (2009):
Gaberel, Thomas, et al. "Intracerebral hematomas disappear on T2*-weighted images during normobaric oxygen therapy." Stroke 44.12 (2013):
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):
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.

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