# MRS DITCH - Magnetic Resonance Selection with DIffusion Tensor Imaging in Cerebral Hemorrhage

> **NIH NIH R21** · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · 2024 · $191,875

## Abstract

Project Summary/Abstract
Penumbral salvage is a central dogma of acute stroke care. Radiological characterization of the penumbra has
transformed acute ischemic stroke care by carefully selecting patients who may benefit from acute intervention.
No such innovation has taken place in intracerebral hemorrhage (ICH). Our central hypothesis is that there is a
“mechanical penumbra” surrounding the hemorrhage - an area that is mechanically compressed and at risk of
becoming irreversibly damaged – but still salvageable if the compression is relieved in a timely manner.
Randomized clinical trials of cerebral hematoma evacuation have not consistently shown a benefit. A potential
explanation for these results is that we have failed to radiologically select patients who may still have salvageable
tissue and are most likely to benefit from hematoma evacuation.
Most ICHs occur in the putamen and thalamus, which border the internal capsule (IC). The internal capsule
consists of the long axons of the corticospinal tract connecting the cortex with the spinal cord. Structural damage
to the IC is the major determinant of functional outcomes after ICH. Preserving the structural integrity of the IC
should therefore be the therapeutic goal. Diffusion-tensor imaging (DTI) is a magnetic resonance-based imaging
technique which allows for the structural assessment of axons in the white matter, such as the IC. DTI detected
damage to the IC highly correlates with long-term functional outcome after ICH. We hypothesize that this
mechanical penumbra in ICH can be evaluated using DTI imaging (using fractional anisotropy (FA) values, and
other measures). Our preliminary data support the feasibility of using DTI imaging and the ability to identify
spatial and temporal shifts of FA values at baseline and in the early hours after ICH. Identifying mechanical
penumbra may facilitate the selection of patients for surgical intervention in future clinical trials.
In this study, we propose serial MR DTI imaging at the time of ICH presentation (< 12h from symptom onset), at
24h, and at 10-14 days after injury in 24 patients. We will analyze DTI sequences for radiological markers of
permanent injury. The IC will be segmented into three zones emanating from the hematoma to determine if
there is a gradient of DTI measures (including FA values). We hypothesize that axons closest to the hemorrhage
have the lowest (damaged axons) and those furthest away from the hemorrhage have the highest (preserved
axons) FA values. Demonstrating such a gradient of FA values around the ICH suggests the presence of axons
with variable degrees of injury, some of which may still be salvageable. (Aim 1) We will then investigate the
temporal evolution of these axons and correlate the impact of this evolution on functional recovery at 3-month
follow-up (Aim 2). We hypothesize that an improved DTI measures is associated with good functional outcomes
whereas a deterioration of FA values over time is associated with ...

## Key facts

- **NIH application ID:** 10868110
- **Project number:** 1R21NS136970-01
- **Recipient organization:** UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
- **Principal Investigator:** Ayham Alkhachroum
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $191,875
- **Award type:** 1
- **Project period:** 2024-02-15 → 2026-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10868110

## Citation

> US National Institutes of Health, RePORTER application 10868110, MRS DITCH - Magnetic Resonance Selection with DIffusion Tensor Imaging in Cerebral Hemorrhage (1R21NS136970-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10868110. Licensed CC0.

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