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Jacquemont T, Valabregue R, Daghsen L, Moulton E, Zavanone C, Lamy JC, Rosso C. Association between superior longitudinal fasciculus, motor recovery, and motor outcome after stroke: a cohort study. Front Neurol 2023; 14:1157625. [PMID: 37521287 PMCID: PMC10375792 DOI: 10.3389/fneur.2023.1157625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Parieto-frontal interactions are mediated by the superior longitudinal fasciculus (SLF) and are crucial to integrate visuomotor information and mediate fine motor control. In this study, we aimed to characterize the relation of white matter integrity of both parts of the SLF (SLF I and SLF II) to both motor outcome and recovery and its evolution over time in stroke patients with upper limb motor deficits. Materials and methods Fractional anisotropy (FA) values over the SLF I, SLF II, and corticospinal tract (CST) and upper limb motor performance evaluated by both the upper limb Fugl-Meyer Assessment score and maximum grip strength were measured for 16 patients at 3 weeks, 6 weeks, and 12 weeks poststroke. FA changes were assessed over time using repeated-measures Friedman ANOVA, and correlations between motor recovery, motor outcome at 12 weeks, and FA values in the CST, SLF I, and SLF II at 3 weeks were performed using Spearman's rank-order correlation. Results FA values in the affected hemisphere's SLF I and SLF II at 3 weeks correlated with motor recovery at 12 weeks when assessed by the Fugl-Meyer Assessment for upper limb extremity (rho: 0.502, p: 0.04 and rho: 0.510, p: 0.04, respectively) but not when assessed by grip strength. FA values in the SLF I and SLF II were not correlated with motor outcomes. FA values in the SLF II in the affected hemisphere changed significantly over time (p: 0.016). Conclusion Both SLF I and SLF II appeared to participate in poststroke motor recovery of complex movements but not in the motor outcome. These results argue that visually/spatially oriented motor tasks as well as more complex motor tasks using parietal associative areas should be used for poststroke rehabilitation strategies.
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Affiliation(s)
- Thomas Jacquemont
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | | | - Lina Daghsen
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Eric Moulton
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Chiara Zavanone
- STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Service de Soins de Suite et Réeducation, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean Charles Lamy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Centre de Neuro-Imagerie de Recherche, CENIR, ICM, Paris, France
| | - Charlotte Rosso
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
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Christidi F, Tsiptsios D, Fotiadou A, Kitmeridou S, Karatzetzou S, Tsamakis K, Sousanidou A, Psatha EA, Karavasilis E, Seimenis I, Kokkotis C, Aggelousis N, Vadikolias K. Diffusion Tensor Imaging as a Prognostic Tool for Recovery in Acute and Hyperacute Stroke. Neurol Int 2022; 14:841-874. [PMID: 36278693 PMCID: PMC9589952 DOI: 10.3390/neurolint14040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Stroke represents a major cause of mortality and long-term disability among adult populations, leaving a devastating socioeconomic impact globally. Clinical manifestation of stroke is characterized by great diversity, ranging from minor disability to considerable neurological impairment interfering with activities of daily living and even death. Prognostic ambiguity has stimulated the interest for implementing stroke recovery biomarkers, including those provided by structural neuroimaging techniques, i.e., diffusion tensor imaging (DTI) and tractography for the study of white matter (WM) integrity. Considering the necessity of prompt and accurate prognosis in stroke survivors along with the potential capacity of DTI as a relevant imaging biomarker, the purpose of our study was to review the pertinent literature published within the last decade regarding DTI as a prognostic tool for recovery in acute and hyperacute stroke. We conducted a thorough literature search in two databases (MEDLINE and Science Direct) in order to trace all relevant studies published between 1 January 2012 and 16 March 2022 using predefined terms as key words. Only full-text human studies published in the English language were included. Forty-four studies were identified and are included in this review. We present main findings and by describing several methodological issues, we highlight shortcomings and gaps in the current literature so that research priorities for future research can be outlined. Our review suggests that DTI can track longitudinal changes and identify prognostic correlates in acute and hyperacute stroke patients.
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Affiliation(s)
- Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Aggeliki Fotiadou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Stella Karatzetzou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK
| | - Anastasia Sousanidou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Evlampia A. Psatha
- Department of Radiology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University, 11527 Athens, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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DiBella EVR, Sharma A, Richards L, Prabhakaran V, Majersik JJ, HashemizadehKolowri SK. Beyond Diffusion Tensor MRI Methods for Improved Characterization of the Brain after Ischemic Stroke: A Review. AJNR Am J Neuroradiol 2022; 43:661-669. [PMID: 35272983 PMCID: PMC9089249 DOI: 10.3174/ajnr.a7414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022]
Abstract
Ischemic stroke is a worldwide problem, with 15 million people experiencing a stroke annually. MR imaging is a valuable tool for understanding and assessing brain changes after stroke and predicting recovery. Of particular interest is the use of diffusion MR imaging in the nonacute stage 1-30 days poststroke. Thousands of articles have been published on the use of diffusion MR imaging in stroke, including several recent articles reviewing the use of DTI for stroke. The goal of this work was to survey and put into context the recent use of diffusion MR imaging methods beyond DTI, including diffusional kurtosis, generalized fractional anisotropy, spherical harmonics methods, and neurite orientation and dispersion models, in patients poststroke. Early studies report that these types of beyond-DTI methods outperform DTI metrics either in being more sensitive to poststroke changes or by better predicting outcome motor scores. More and larger studies are needed to confirm the improved prediction of stroke recovery with the beyond-DTI methods.
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Affiliation(s)
- E V R DiBella
- From the Departments of Radiology and Imaging Sciences (E.V.R.D., A.S., S.K.H.)
| | - A Sharma
- From the Departments of Radiology and Imaging Sciences (E.V.R.D., A.S., S.K.H.)
| | - L Richards
- Occupational and Recreational Therapies (L.R.)
| | - V Prabhakaran
- Department of Radiology (V.P.), University of Wisconsin, Madison, Wisconsin
| | - J J Majersik
- Neurology (J.J.M.), University of Utah, Salt Lake City, Utah
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Brain Abnormalities in Pontine Infarction: A Longitudinal Diffusion Tensor Imaging and Functional Magnetic Resonance Imaging study. J Stroke Cerebrovasc Dis 2021; 31:106205. [PMID: 34879300 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The aim of this study was to make a reasonable and accurate assessment of the prognosis of patients with pontine infarction. We assessed the changes in structure and function in the whole brain after pontine infarction from the acute to chronic phase using diffustion tensor imaging and functional magnetic resonance imaging. MATERIALS AND METHODS Sixteen individuals with a recent pontine infarction and sixteen healthy controls were recruited and underwent 3.0T DTI, resting-state fMRI and upper extremity Fugl-Myer (UE-FM) functional evaluation at five time points: within one week (T1), half a month (T2), one month (T3), three months (T4), and six months (T5) after onset. Tract-based spatial statistics was used to conduct a voxelwise analysis. RESULTS The fractional anisotropy (FA) values were significantly lower in the pontine infarction group than in the control group. Then, specific ROIs were analyzed. The FA values of 10 regions of interest were significantly increased at T2 compared with those at T1. The FA value of the corticospinal tract was significantly increased at T3 compared with that at T2. Regional brain activity results showed that the amplitude of low frequency fluctuations value of the frontal lobe decreased at T1, then increased. Finally, The UE-FM scores showed the same increased trend. CONCLUSION These findings show that the microstructure changes most significantly within half a month after pontine infarction and stabilizes after one month. The recovery of motor function in the later period is mainly caused by changes in the cortex. This facilitates more treatment options.
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A systematic review of the usefulness of magnetic resonance imaging in predicting the gait ability of stroke patients. Sci Rep 2021; 11:14338. [PMID: 34253774 PMCID: PMC8275756 DOI: 10.1038/s41598-021-93717-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/07/2021] [Indexed: 11/08/2022] Open
Abstract
The usefulness of magnetic resonance imaging (MRI) in predicting gait ability in stroke patients remains unclear. Therefore, MRI evaluations have not yet been standardized in stroke rehabilitation. We performed a systematic review to consolidate evidence regarding the use of MRIs in predicting gait ability of stroke patients. The Medline, Cumulative Index to Nursing and Allied Health Literature, and SCOPUS databases were comprehensively searched. We included all literature published from each source’s earliest date to August 2020. We included 19 studies: 8 were classified as structure- or function-based MRI studies and 11 as neural tract integrity-based MRI studies. Most structure- or function-based MRI studies indicated that damage to motor-related areas (primary motor cortex, corona radiata, internal capsule, and basal ganglia) or insula was related to poor gait recovery. In neural tract integrity-based MRI studies, integrity of the corticospinal tract was related to gait ability. Some studies reported predictive value of the corticoreticular pathway. All included studies had some concerns, at least one, based on the Cochrane risk of bias instrument. This review suggests that MRIs are useful in predicting gait ability of stroke patients. However, we cannot make definitive conclusion regarding the predictive value, due to the lack of quantitative evaluations.
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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] [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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Multivariate Prognostic Model of Acute Stroke Combining Admission Infarct Location and Symptom Severity: A Proof-of-Concept Study. J Stroke Cerebrovasc Dis 2017; 27:936-944. [PMID: 29198948 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/23/2017] [Accepted: 10/29/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The information on topographic distribution of acute ischemic infarct can contribute to prediction of functional outcome. We aimed to develop a multivariate model for stroke prognostication, combining admission clinical and imaging variables, including the infarct topology. METHODS Acute ischemic stroke patients without baseline functional disability who had magnetic resonance imaging within 24 hours of onset or last-seen-well were included. The admission stroke severity was determined using the National Institutes of Health Stroke Scale (NIHSS) score. The relation between infarct location and outcome was assessed using both voxel-based and visual atlas-based analyses. The disability/death was defined by a modified Rankin Scale score greater than 2 at 3-month follow-up. RESULTS Among 198 patients included in this study, higher admission NIHSS score (P < .001), larger infarct volume (P < .001), and major arterial occlusions (P < .001) were associated with disability/death in univariate analyses. On voxel-based analysis, infarcts in the middle centrum semiovale, insula, and midbrain/pons were associated with higher rates of disability/death. In multivariate analysis, admission NIHSS score (P < .001), infarction of insula (P = .005), and midbrain/pons (P = .006) were independent predictors of disability/death. In receiver operating characteristics analysis, a simple 0-to-3 scoring system using these 3 variables had an area under the curve of .812 for prediction of disability/death (P < .001). CONCLUSIONS Admission symptom severity, infarction of insula, and midbrain/pons were independent predictors of clinical outcome in acute ischemic stroke patients. The methodology of this hypothesis-generating study can help conceive quantitative population-based probabilistic models for prognostication or treatment triage in stroke patients, combining admission clinical and imaging findings-including infarct topography.
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