A study designed to determine how magnetic resonance imaging (MRI) can be used to help clinicians treat patients with brain hemorrhages is underway at The University of Texas Health Science Center at Houston (UTHealth Houston).

The trial, led by Muhammad Haque, PhD, assistant professor of neurology with McGovern Medical School at UTHealth Houston and the UTHealth Institute for Stroke and Cerebrovascular Disease, is investigating a special MRI protocol to help understand which patients might be at risk for hematoma expansion and determining when patients might be safely placed back on anti-thrombotic medications such as aspirin. Hematoma expansion is a pool of clotted blood that can occur after a blood vessel breaks.

The current standard of care is a computed tomography (CT) scan, a noninvasive X-ray used to detect any bleeding. Both the CT and MRI scans are capable of locating and detecting hematoma expansion, but Haque believes a slight modification to existing MRI protocols can differentiate between clotted (or coagulated) versus nonclotted (or noncoagulated) blood within the hematoma.

“We are studying whether MRI can provide more complete information which could alter the clinical management of patients with hemorrhagic stroke,” Haque said. “The current practice of CT scans is inadequate for the full assessment of patients. We seek to assist providers with information that will help them plan early interventions and might even eliminate unnecessary surgical procedures. Our ultimate goal is to take this data and go for an extensive study of this imaging method.”

Intracerebral hemorrhage – a type of brain bleed that occurs anywhere within brain tissue – accounts for about 10% to 15% of all strokes and is associated with high mortality. It is most commonly the result of hypertension, which can cause the thin-walled arteries that bring blood to areas deep inside the brain to rupture, releasing blood into brain tissue. As blood spills into and puts pressure on the brain, it becomes deprived of oxygen and blood supply. Brain cells die, and the resulting inflammatory responses damage more cells in the area surrounding the hematoma.

There is a 30%-40% mortality rate for intracerebral hemorrhage, Haque said, with 73% of patients experiencing some degree of hematoma growth, and with about one-third of them exhibiting hematoma expansion – a 33% growth of hematoma volume within 24 hours of intracerebral hemorrhage.

“With this MRI sequence, we hope to see within the hematoma what percentage of the blood is already clotted and what percentage is in the liquid form,” Haque said. “We will determine if patients with mostly clotted blood are less likely to see their blood expand.”

The study, which has been taking place at Memorial Hermann-Texas Medical Center since October, is being funded by the Lone Star Stroke Consortium, a collaboration among leading medical research institutions in Texas to improve the health of Texans affected by stroke and cerebrovascular disease.

Among others, the consortium is helmed by study co-investigators James Grotta, MD, director of stroke research with the Clinical Institute for Research and Innovation at Memorial Hermann-TMC and neurologist with the Memorial Hermann Medical Group, and Sean Savitz, MD, professor and the Frank M. Yatsu, MD, Chair in Neurology with McGovern Medical School. Jaroslaw Aronowski, MD, PhD, professor and the Roy M. and Phyllis Gough Huffington Chair in Neurology with McGovern Medical School, is also a study co-investigator.

Grotta founded the stroke program at UTHealth Houston in 1979. Today, Savitz directs the UTHealth Stroke Institute, and Aronowski is a member of the institute. Savitz and Aronowski are also faculty members with The University of Texas MD Anderson Cancer Center Graduate School of Biomedical Sciences.

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