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Zhu W, Deng S, Jiang H, Zhang J, Li B, Jia Q, Meng Z. Assessment of corticospinal tract remodeling based on diffusion tensor imaging in the treatment of motor dysfunction after ischemic stroke by acupuncture: A meta-analysis. Medicine (Baltimore) 2023; 102:e34618. [PMID: 37565876 PMCID: PMC10419801 DOI: 10.1097/md.0000000000034618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND To investigate the efficacy of acupuncture in improving motor dysfunction after ischemic stroke (IS) and to investigate the effect of acupuncture on corticospinal tract (CST) remodeling using diffusion tensor imaging. METHODS Published literature on the effect of acupuncture on CST remodeling after IS using diffusion tensor imaging in the form of randomized controlled trials (RCTs) were systematically retrieved and screened from Cochrane Library, Web of Science, PubMed, Embase, CNKI, CBM, VIP, and Wanfang databases from inception to December 2022. The methodological quality of the included studies was critically and independently evaluated by 2 reviewers using the Cochrane Risk of Bias Assessment Tool for RCTs. The correlated data were extracted using the pre-designed form, and all analyses were performed using Reviewer Manager version 5.4. RESULTS Eleven eligible RCTs involving 459 patients were eventually included. The combined evidence results showed that the acupuncture group significantly improved patients' National Institute of Health stroke scale, Fugl-Meyer Assessment Scale, and Barthel index compared with conventional medical treatment. The acupuncture group significantly promoted remodeling of the CST, as reflected by an increase in fractional anisotropy (FA) throughout the CST [MD = 0.04, 95% CI (0.02, 0.07), P = .001], and in addition, subgroup analysis showed that the acupuncture group significantly improved FA in the infarct area compared with conventional medical treatment at around 4 weeks [MD = 0.04, 95% CI (0.02, 0.06), P = .0002] and FA of the affected cerebral peduncle [MD = 0.03, 95% CI (0.00, 0.07), P = .02]. Also, compared with conventional medical treatment, the acupuncture group significantly increased average diffusion coefficient of the affected cerebral peduncle [MD = -0.21, 95% CI (-0.28, -0.13), P < .00001]. CONCLUSION The results of the meta-analysis suggest that acupuncture therapy can improve the clinical manifestations of motor dysfunction in patients after IS and advance a possibly beneficial effect on CST remodeling. However, due to the number and quality of eligible studies, these findings need to be further validated in more standardized, rigorous, high-quality clinical trials.
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Affiliation(s)
- Weiming Zhu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shizhe Deng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hailun Jiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jieying Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Boxuan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qingqing Jia
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhihong Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Weili S, Qingyang M, Nayun C, Yong M, Yuping Y, Ping L, Yingfang A, Xi G. Patients with isolated posterior cruciate ligament rupture had a higher posterior intercondylar eminence. BMC Musculoskelet Disord 2022; 23:276. [PMID: 35321666 PMCID: PMC8943983 DOI: 10.1186/s12891-022-05189-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the anatomic geometry of the posterior intercondylar eminence and its association with PCL injury risk. Methods Patients who underwent primary PCL reconstruction from 2015 to 2018 were retrospectively analyzed. The control group included inpatients diagnosed with ACL rupture because of a sports-related accident during the same period, matched by age, gender, height, weight, and side of injury. Measurements of the height of the apex of the posterior intercondylar eminence (HPIE), the slope length (SLPIE) and the slope angle (SAPIE) of the posterior intercondylar eminence were performed using conventional MRI scans assessed by 2 blinded, independent raters. Intraclass correlation coefficients (ICCs) was used to evaluate the consistency of measurement results. Independent sample t tests, Chi-square tests, and logistic analyses were used to compare the two group, with P < 0.05 considered statistically significant. Results Fifty-five patients with PCL rupture met the inclusion criteria and 55 PCL-intact matched controls were included. There were no significant differences between the groups in gender (P = 1.000), limb side (P = 0.848), age (P = 0.291), BMI (P = 0.444) or height (P = 0.290). Inter-observer reproducibility was excellent agreement in HPIE, SLPIE and SAPIE of case and control groups (ICC: HPIE = 0.81, SLPIE = 0.77, SAPIE = 0.85). Patients with PCL rupture had significantly greater HPIE, SAPIE (both P < 0.001), and SLPIE (P < 0.05) than PCL-intact patients. The multivariable analysis showed that HPIE (OR, 1.62 [95% CI, 1.24–2.11], P < 0.001) and SAPIE (OR, 1.17 [95% CI, 1.05–1.31], P < 0.001) were independent factors associated with PCL rupture. Conclusion Through this retrospective observational study, we found that patients with PCL rupture may have a higher posterior intercondylar eminence compared to PCL-intact patients. Level of evidence III.
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Affiliation(s)
- Shi Weili
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Meng Qingyang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Chen Nayun
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ma Yong
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yang Yuping
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Liu Ping
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ao Yingfang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China.
| | - Gong Xi
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China.
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Lewis AF, Myers M, Heiser J, Kolar M, Baird JF, Stewart JC. Test-retest reliability and minimal detectable change of corticospinal tract integrity in chronic stroke. Hum Brain Mapp 2020; 41:2514-2526. [PMID: 32090440 PMCID: PMC7268047 DOI: 10.1002/hbm.24961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023] Open
Abstract
Diffusion tensor imaging (DTI) can be used to index white matter integrity of the corticospinal tract (CST) after stroke; however, the psychometric properties of DTI-based measures of white matter integrity are unknown. The purpose of this study was to examine test-retest reliability as determined by intraclass correlation coefficients (ICC) and calculate minimal detectable change (MDC) of DTI-based measures of CST integrity using three different approaches: a Cerebral Peduncle approach, a Probabilistic Tract approach, and a Tract Template approach. Eighteen participants with chronic stroke underwent DTI on the same magnetic resonance imaging scanner 4 days apart. For the Cerebral Peduncle approach, a researcher hand drew masks at the cerebral peduncle. For the Probabilistic Tract approach, tractography was seeded in motor areas of the cortex to the cerebral peduncle. For the Tract Template approach, a standard CST template was transformed into native space. For all approaches, the researcher performing analyses was blind to participant number and day of data collection. All three approaches had good to excellent test-retest reliability for fractional anisotropy (FA; ICCs >0.786). Mean diffusivity, axial diffusivity, and radial diffusivity were less reliable than FA. The ICC values were highest and MDC values were the smallest for the most automated approach (Tract Template), followed by the combined manual/automated approach (Probabilistic Tract) then the manual approach (Cerebral Peduncle). The results of this study may have implications for how DTI-based measures of CST integrity are used to define impairment, predict outcomes, and interpret change after stroke.
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Affiliation(s)
- Allison F. Lewis
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Makenzie Myers
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jenny Heiser
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Melissa Kolar
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jessica F. Baird
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jill C. Stewart
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
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Dalamagkas K, Tsintou M, Rathi Y, O'Donnell LJ, Pasternak O, Gong X, Zhu A, Savadjiev P, Papadimitriou GM, Kubicki M, Yeterian EH, Makris N. Individual variations of the human corticospinal tract and its hand-related motor fibers using diffusion MRI tractography. Brain Imaging Behav 2020; 14:696-714. [PMID: 30617788 PMCID: PMC6614022 DOI: 10.1007/s11682-018-0006-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The corticospinal tract (CST) is one of the most well studied tracts in human neuroanatomy. Its clinical significance can be demonstrated in many notable traumatic conditions and diseases such as stroke, spinal cord injury (SCI) or amyotrophic lateral sclerosis (ALS). With the advent of diffusion MRI and tractography the computational representation of the human CST in a 3D model became available. However, the representation of the entire CST and, specifically, the hand motor area has remained elusive. In this paper we propose a novel method, using manually drawn ROIs based on robustly identifiable neuroanatomic structures to delineate the entire CST and isolate its hand motor representation as well as to estimate their variability and generate a database of their volume, length and biophysical parameters. Using 37 healthy human subjects we performed a qualitative and quantitative analysis of the CST and the hand-related motor fiber tracts (HMFTs). Finally, we have created variability heat maps from 37 subjects for both the aforementioned tracts, which could be utilized as a reference for future studies with clinical focus to explore neuropathology in both trauma and disease states.
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Affiliation(s)
- Kyriakos Dalamagkas
- Surgical Planning Laboratory, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston, Boston, MA, 02215, USA
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
- UCL Division of Surgery & Interventional Science, Center for Nanotechnology & Regenerative Medicine, University College London, London, UK
| | - Magdalini Tsintou
- Surgical Planning Laboratory, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston, Boston, MA, 02215, USA
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- UCL Division of Surgery & Interventional Science, Center for Nanotechnology & Regenerative Medicine, University College London, London, UK
- Departments of Psychiatry and Neurology Services, Center for Neural Systems Investigations, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
| | - Yogesh Rathi
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren J O'Donnell
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Peter Savadjiev
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George M Papadimitriou
- Departments of Psychiatry and Neurology Services, Center for Neural Systems Investigations, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
| | - Marek Kubicki
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Departments of Psychiatry and Neurology Services, Center for Neural Systems Investigations, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Nikos Makris
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Departments of Psychiatry and Neurology Services, Center for Neural Systems Investigations, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA.
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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Nha K, Nam YJ, Shin MJ, Sun SD, Park JY, Debnath R, Lee BH. Referencing the trochlear groove based on three-dimensional computed tomography imaging improves the reliability of the measurement of the tibial tuberosity-trochlear groove distance in patients with higher grades of trochlea dysplasia. Knee 2019; 26:1429-1436. [PMID: 31176603 DOI: 10.1016/j.knee.2019.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/08/2019] [Accepted: 05/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To determine whether 3D-CT imaging technique is valid and reproducible compared to conventional CT measurement technique (CCT) for the detection of a femoropatellar instability. METHODS Patients who had undergone surgery for femoropatellar instability (patellar instability group) between 2010 and 2016 (n = 37 knees of 35 patients) were retrospectively enrolled. For the matched control group, patients who had acute anterior cruciate ligament injury (<4 weeks previously; n = 30) were recruited. Preoperative CT data had been obtained in all patients. Inter-rater reliability was calculated for both measurement protocols, and inter-method reliability was calculated between the two imaging modalities. The results are reported using intraclass correlation coefficients (ICCs) and Bland-Altman 95% limits of agreement. RESULTS All patients in the patellar instability group had femoral trochlear dysplasia (Dejour types A: four, B: 19, C: seven, and D: six), but no dysplasia was noted in the control group. In the patellar instability group, the CCT technique showed a poor inter-rater agreement (ICC = 0.74), and the 3D-CT technique still showed excellent inter-rater agreement (ICCs = 0.91). In the sub-analysis of the patellar instability group according to the trochlear dysplasia grade, ICCs were markedly decreased with severe trochlear dysplasia when using CCT technique; however, the 3D-CT technique could provide excellent reliability even with severe trochlear dysplasia. CONCLUSION The 3D-CT imaging technique for the measurement of the TT-TG distance can be suggested as a better measurement technique for patellar instability patients with bone abnormality.
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Affiliation(s)
- KyungWook Nha
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Republic of Korea
| | - Young Jun Nam
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Republic of Korea
| | - Myung Jin Shin
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Republic of Korea
| | | | | | - Rajib Debnath
- Tripura Medical College & Dr. B.R. Ambedkar Memorial Teaching Hospital, India
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University, Gil Medical Center, Incheon, Republic of Korea.
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Moura LM, Luccas R, de Paiva JPQ, Amaro E, Leemans A, Leite CDC, Otaduy MCG, Conforto AB. Diffusion Tensor Imaging Biomarkers to Predict Motor Outcomes in Stroke: A Narrative Review. Front Neurol 2019; 10:445. [PMID: 31156529 PMCID: PMC6530391 DOI: 10.3389/fneur.2019.00445] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/12/2019] [Indexed: 12/14/2022] Open
Abstract
Stroke is a leading cause of disability worldwide. Motor impairments occur in most of the patients with stroke in the acute phase and contribute substantially to disability. Diffusion tensor imaging (DTI) biomarkers such as fractional anisotropy (FA) measured at an early phase after stroke have emerged as potential predictors of motor recovery. In this narrative review, we: (1) review key concepts of diffusion MRI (dMRI); (2) present an overview of state-of-art methodological aspects of data collection, analysis and reporting; and (3) critically review challenges of DTI in stroke as well as results of studies that investigated the correlation between DTI metrics within the corticospinal tract and motor outcomes at different stages after stroke. We reviewed studies published between January, 2008 and December, 2018, that reported correlations between DTI metrics collected within the first 24 h (hyperacute), 2-7 days (acute), and >7-90 days (early subacute) after stroke. Nineteen studies were included. Our review shows that there is no consensus about gold standards for DTI data collection or processing. We found great methodological differences across studies that evaluated DTI metrics within the corticospinal tract. Despite heterogeneity in stroke lesions and analysis approaches, the majority of studies reported significant correlations between DTI biomarkers and motor impairments. It remains to be determined whether DTI results could enhance the predictive value of motor disability models based on clinical and neurophysiological variables.
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Affiliation(s)
- Luciana M. Moura
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Rafael Luccas
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | | | - Edson Amaro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Alexander Leemans
- PROVIDI Lab, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands
| | - Claudia da C. Leite
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Maria C. G. Otaduy
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Adriana B. Conforto
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Abstract
BACKGROUND Information about the structural integrity of the corticospinal tract (CST) from diffusion-weighted imaging can improve our ability to understand motor outcomes in people with upper limb impairment after stroke, especially those with severe impairment. Yet, there is no consensus on which method of CST generation most accurately represents function and impairment in individuals with chronic stroke. NEW METHOD The aim of the study was to compare different methods of CST reconstruction and resulting microstructural properties, as well as the relationship between these properties and motor function and impairment. Fifteen individuals with mild-moderate impairment and 15 with severe impairment who were in the chronic phase post-stroke underwent a diffusion-weighted imaging scan and motor function and impairment assessments. RESULTS Different relationships existed between reconstruction methods, microstructural properties, and impairment and function. In severe stroke, fractional anisotropy (FA) emerged over and above apparent diffusion coefficient (ADC) and tract number to index CST integrity; FA correlated with impairment and function, whereas ADC and tract number did not correlate. No significant differences between methods or microstructural properties were found in mild-moderate stroke. COMPARISON WITH EXISTING METHODS Our study demonstrates that CST reconstruction method influences the extraction of microstructural integrity in individuals with chronic severe stroke, with FA appearing to be the most representative method. A similar line of investigation is warranted earlier post-stroke. CONCLUSION Differences in this data set highlight the need to establish a common methodology for CST reconstruction and analysis which may eliminate discrepancies in interpreting DWI and enhance biomarker use post-stroke for motor function.
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Affiliation(s)
- S J Feldman
- Graduate Program in Neuroscience, Faculty of Medicine, University of British Columbia, Vancouver BC, V6T 1Z3, Canada
| | - L A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver BC, V6T 1Z3, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver BC, V6T 1Z3, Canada
| | - J L Neva
- Department of Physical Therapy, University of British Columbia, Vancouver BC, V6T 1Z3, Canada
| | - S Peters
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver BC, V6T 1Z3, Canada
| | - K S Hayward
- Department of Physical Therapy, University of British Columbia, Vancouver BC, V6T 1Z3, Canada; Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne VIC, 3084, Australia; NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia.
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Hayward KS, Neva JL, Mang CS, Peters S, Wadden KP, Ferris JK, Boyd LA. Interhemispheric Pathways Are Important for Motor Outcome in Individuals with Chronic and Severe Upper Limb Impairment Post Stroke. Neural Plast 2017; 2017:4281532. [PMID: 29348943 DOI: 10.1155/2017/4281532] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/27/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background Severity of arm impairment alone does not explain motor outcomes in people with severe impairment post stroke. Objective Define the contribution of brain biomarkers to upper limb motor outcomes in people with severe arm impairment post stroke. Methods Paretic arm impairment (Fugl-Meyer upper limb, FM-UL) and function (Wolf Motor Function Test rate, WMFT-rate) were measured in 15 individuals with severe (FM-UL ≤ 30/66) and 14 with mild–moderate (FM-UL > 40/66) impairment. Transcranial magnetic stimulation and diffusion weight imaging indexed structure and function of the corticospinal tract and corpus callosum. Separate models of the relationship between possible biomarkers and motor outcomes at a single chronic (≥6 months) time point post stroke were performed. Results Age (ΔR20.365, p = 0.017) and ipsilesional-transcallosal inhibition (ΔR20.182, p = 0.048) explained a 54.7% (p = 0.009) variance in paretic WMFT-rate. Prefrontal corpus callous fractional anisotropy (PF-CC FA) alone explained 49.3% (p = 0.007) variance in FM-UL outcome. The same models did not explain significant variance in mild–moderate stroke. In the severe group, k-means cluster analysis of PF-CC FA distinguished two subgroups, separated by a clinically meaningful and significant difference in motor impairment (p = 0.049) and function (p = 0.006) outcomes. Conclusion Corpus callosum function and structure were identified as possible biomarkers of motor outcome in people with chronic and severe arm impairment.
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Stefanou MI, Lumsden DE, Ashmore J, Ashkan K, Lin JP, Charles-Edwards G. Tensor and non-tensor tractography for the assessment of the corticospinal tract of children with motor disorders: a comparative study. Neuroradiology 2016; 58:1005-1016. [PMID: 27447871 DOI: 10.1007/s00234-016-1721-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/21/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Non-invasive measures of corticospinal tract (CST) integrity may help to guide clinical interventions, particularly in children and young people (CAYP) with motor disorders. We compared diffusion tensor imaging (DTI) metrics extracted from the CST generated by tensor and non-tensor based tractography algorithms. METHODS For a group of 25 CAYP undergoing clinical evaluation, the CST was reconstructed using (1) deterministic tensor-based tractography algorithm, (2) probabilistic tensor-based, and (3) constrained spherical deconvolution (CSD)-derived tractography algorithms. RESULTS Choice of tractography algorithm significantly altered the results of tracking. Larger tracts were consistently defined with CSD, with differences in FA but not MD values for tracts to the pre- or post-central gyrus. Differences between deterministic and probabilistic tensor-based algorithms were minimal. Non-tensor reconstructed tracts appeared to be more anatomically representative. Examining metrics along the tract, difference in FA values appeared to be greatest in voxels with predominantly single-fibre orientations. Less pronounced differences were seen outwith of these regions. CONCLUSION With an increasing interest in the applications of tractography analysis at all stages of movement disorder surgery, it is important that clinicians remain alert to the consequences of choice of tractography algorithm on subsequently generated tracts, including differences in volumes, anatomical reconstruction, and DTI metrics, the latter of which will have global as well as more regional effects. Tract-wide analysis of DTI based metrics is of limited utility, and a more segmental approach to analysis may be appropriate, particularly if disruption to a focal region of a white matter pathway is anticipated.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Daniel E Lumsden
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK.
- Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminister Bridge Road, London, SE1 7EH, UK.
| | - Jonathan Ashmore
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK
- Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Functional Neurosurgery, Department of Neurosurgery, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
- Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jean-Pierre Lin
- Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminister Bridge Road, London, SE1 7EH, UK
| | - Geoffrey Charles-Edwards
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK
- Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Li Z, Li N, Qu Y, Gai F, Zhang G, Zhang G. Application of 3.0T magnetic resonance arterial spin labeling (ASL) technology in mild and moderate intracranial atherosclerotic stenosis. Exp Ther Med 2016; 12:297-301. [PMID: 27347052 PMCID: PMC4907036 DOI: 10.3892/etm.2016.3318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/06/2016] [Indexed: 11/05/2022] Open
Abstract
The application value of 3.0T magnetic resonance arterial spin labeling (ASL) technology in mild and moderate intracranial atherosclerotic stenosis was evaluated. A total of 58 cases of transient ischemic attack (TIA) and 60 cases of ischemic cerebral apoplexy cases were selected. The cases were analysed using a GE Healthcare Signa HDx 3.0T superconducting whole-body magnetic resonance scan within 24 h of attack. Eight-channel head phased array coils and conventional sequence were used to create T1-weighted images (T1WI), T2WI, diffusion-weighted imaging, magnetic resonance angiography (MRA) and ASL imaging, which were generated into ASL pseudo-color images (blue was hypoperfusion area) through post-processing in order to compare and analyze the correlation and differences between ASL and conventional imaging in terms of lesion location, size, blood perfusion situation and signal range of relative cerebral blood flow (rCBF). The results showed that, 13 TIA cases of abnormal signal in conventional magnetic resonance imaging (MRI) can also be found through ASL technology. Diameter stenosis beyond 30% in MRA can also be tested in ASL. A positive rate in ASL was significantly higher than that of conventional MRI (χ2=29.078, P<0.001) and hypoperfusion area was greatly increased (t=32.526, P<0.001). The rCBF value was positively correlated with the degree of diameter stenosis shown in MRA (r=0.524, P=0.012). Additionally, the positive rate of ASL was positively correlated with the attack times of TIA (r=0.352, P=0.027). A total of 39 cerebral apoplexy cases of abnormal signal in conventional MRI were also found through ASL technology. A positive rate in ASL was significantly higher than that of conventional MRI (χ2=7.685, P=0.006) and hypoperfusion area was greatly increased (t=9.425, P<0.001). The rCBF value was positively correlated with the degree of diameter stenosis (r=0.635, P=0.009). In conclusion, 3.0T ASL correlated with early diagnosis of TIA and mild and moderate intracranial arterial stenosis of cerebral apoplexy.
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Affiliation(s)
- Zhongwei Li
- CT Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Naikun Li
- Department of Medical Imaging, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Yanyan Qu
- Department of Endocrinology, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Feng Gai
- Department of Radiology, Yantai Municipal Laiyang Central Hospital, Yantai, Shandong 265200, P.R. China
| | - Guowei Zhang
- CT Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Guanghui Zhang
- Department of Medical Imaging, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
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Lee BH, Choi KH, Seo DY, Choi SM, Kim GL. Diagnostic validity of alternative manual stress radiographic technique detecting subtalar instability with concomitant ankle instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:1029-39. [PMID: 26869035 DOI: 10.1007/s00167-016-4037-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To incorporate a diagnostic technique for measuring subtalar motion, namely "talar rotation", into the manual supination-anterior drawer stress radiographs for evaluation of the severity of rotational instability, and to determine its clinical relevance. METHODS Sixty-six patients with combined injuries of the anterior talofibular (ATFL) and calcaneofibular ligament (CFL) underwent three bilateral manual stress radiographs, and mean increments of anterior talar translation (mm), talar tilt (°), and talar rotation (%) in the injured ankle compared to the normal opposite side were measured with the technique. Intraobserver and interobserver reliability of each measure was assessed, and the difference in the degree of increments was compared according to the presence of additional cervical ligament insufficiency. RESULTS Ankle stress radiographic intraobserver and interobserver agreement was ICC = 0.91 and 0.82 for talar rotation (%), ICC = 0.64 and 0.51 for anterior talar translation, and ICC = 0.78 and 0.71 for talar tilt angle, respectively. In group 2 including patients with combined injuries of the ATFL and CFL along with additional cervical ligament insufficiency, a significantly higher increment of talar rotation, mean 6.4% (SD 3.4%), was observed compared to that of talar rotation, mean 4.1% (SD 2.7 ), in the other group (group 1) with an intact cervical ligament (p < 0.001). CONCLUSIONS A new comprehensive stress radiographic technique for diagnosis of chronic lateral ankle instability presented in this study might be a reliable and representable measurement tool to assess additional injury or instability of the subtalar joint. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Byung Hoon Lee
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, Korea
| | - Kyung-Hwa Choi
- Hallym Research Institute of Clinical Epidemiology, Hallym University, 1 Hallymdaehak-gil, Chuncheon, Gangwon-do, 200-702, Korea
| | - Dong Yeon Seo
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, Korea
| | - Sang Min Choi
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, Korea
| | - Gab Lae Kim
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, Korea.
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