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Gao Y, Zhang K, Liu H, Zong C, Yang H, Yao Y, Xu Y. Lesion Indexes Predict Early Neurologic Deterioration in Lenticulostriate Single Small Subcortical Infarction. AJNR Am J Neuroradiol 2024; 45:568-573. [PMID: 38724189 DOI: 10.3174/ajnr.a8176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/08/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND AND PURPOSE Early neurologic deterioration (END) often occurs during hospitalization in single small subcortical infarction (SSSI). The objective was to identify imaging predictors of END. MATERIALS AND METHODS SSSIs in the lenticulostriate artery within 72 hours of stroke onset from January 2015 to June 2021 were consecutively enrolled. The posteriority and laterality indexes were assessed on the second section from the top of the corona radiata section showing the lateral ventricle on DWI. A multivariate logistic analysis was used to explore the predictors of END. RESULTS A total of 402 patients were included in this study, among whom 93 (23.1%) experienced END. The optimal cutoff points of the posteriority and laterality indexes for predicting END were given by a receiver operating characteristic curve. A multivariate logistic analysis showed that the posteriority index of ≥0.669 (OR: 2.53; 95% CI: 1.41-4.56; P = .002) and the laterality index of ≥0.950 (OR: 2.03; 95% CI: 1.03-4.00; P = .042) were independently associated with the risk of END. Accordingly, the SSSIs were further divided into 4 types: anterior lateral type (AL-type), anterior medial type (AM-type), posterior lateral type (PL-type), and posterior medial type (PM-type). After the multivariate analysis, in comparison with the AL-type, the AM-type (OR: 3.26; 95% CI: 1.10-9.65), PL-type (OR: 4.68; 95% CI: 1.41-15.56), and PM-type (OR: 6.77; 95% CI: 2.53-18.04) carried significantly elevated risks of END. The PM-type was associated with the highest risk of END. CONCLUSIONS The PM-type was found to be associated with the highest risk of END.
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Affiliation(s)
- Yuan Gao
- From the Department of Neurology (Y.G., K.Z., H.L., C.Z., H.Y., Y.Y., Y.X.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ke Zhang
- From the Department of Neurology (Y.G., K.Z., H.L., C.Z., H.Y., Y.Y., Y.X.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Hongbing Liu
- From the Department of Neurology (Y.G., K.Z., H.L., C.Z., H.Y., Y.Y., Y.X.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ce Zong
- From the Department of Neurology (Y.G., K.Z., H.L., C.Z., H.Y., Y.Y., Y.X.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Hongxun Yang
- From the Department of Neurology (Y.G., K.Z., H.L., C.Z., H.Y., Y.Y., Y.X.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ying Yao
- From the Department of Neurology (Y.G., K.Z., H.L., C.Z., H.Y., Y.Y., Y.X.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuming Xu
- From the Department of Neurology (Y.G., K.Z., H.L., C.Z., H.Y., Y.Y., Y.X.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease (Y.X.)
- Henan Key Laboratory of Cerebrovascular Diseases (Zhengzhou University), (Y.X.), Zhengzhou, Henan Province, China
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Kim MS, Moon BS, Ahn JY, Shim SS, Yun JM, Joo MC. Elucidating the mechanisms of post-stroke motor recovery mediated by electroacupuncture using diffusion tensor tractography. Front Neurol 2022; 13:888165. [PMID: 36237615 PMCID: PMC9551655 DOI: 10.3389/fneur.2022.888165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
Acupuncture has been commonly used for post-stroke patients, and electroacupuncture allows simultaneous application of acupuncture and electrical stimulation. We aimed to elucidate the mechanism of electroacupuncture on post-stroke motor recovery using diffusion tensor tractography. A total of 33 subacute stroke patients were recruited. The control group was subjected to conventional rehabilitation therapy. In contrast, the patients in the experimental group received electroacupuncture treatment for 30 min per session for 4 weeks in addition to the rehabilitation therapy. Fugl-Meyer assessment of the lower extremity (FMA_L), functional ambulation categories (FAC), and the Korean version of modified Barthel index (K-MBI) were used to compare behavioral outcomes between groups. The corticospinal tract (CST) was examined before and after the intervention via diffusion tensor tractography (DTT) to determine the motor recovery mechanism mediated by electroacupuncture. After 4 weeks of intervention, both the control and experimental groups showed a significant improvement with respect to FMA_L, FAC, and K-MBI. The level of improvement in FMA_L, FAC, and K-MBI did not vary significantly between the two groups. However, DTT results showed that the CST fractional anisotropy of the affected side (control: from 0.456 to 0.464, experimental: from 0.459 to 0.512) and its ratio (control: from 89.8 to 90.3, experimental: from 90.2 to 93.3) were significantly different between the two groups (p = 0.032 and p = 0.018). In addition, there were significant differences in the CST axial diffusivity of affected side (control: from 0.783 to 0.877, experimental: from 0.840 to 0.897) and its ratio variation (control: from 87.9 to 100.0, experimental: from 95.7 to 100.7) between the groups (p = 0.003 and p = 0.001). Electroacupuncture played a role in promoting brain plasticity and delaying neural degeneration in subacute period after stroke. Thus, electroacupuncture could be an effective adjuvant therapy in addition to conventional rehabilitation for motor recovery after stroke in a long-term perspective.
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Affiliation(s)
- Min Su Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Byung Soon Moon
- Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan, South Korea
| | - Jae-yoon Ahn
- Department of Korean Internal Medicine, College of Korean Medicine, Wonkwang University, Iksan, South Korea
| | - Sang-song Shim
- Department of Korean Internal Medicine, College of Korean Medicine, Wonkwang University, Iksan, South Korea
| | - Jong-Min Yun
- Department of Korean Internal Medicine, College of Korean Medicine, Wonkwang University, Iksan, South Korea
- Jong-Min Yun
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University College of Medicine, Iksan, South Korea
- *Correspondence: Min Cheol Joo
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SatoMD T, SakaiMD K, TakatsuMD H, TanabeMD M, KomatsuMD T, SakutaMD K, TerasawaMD Y, UmeharaMD T, OmotoMD S, MurakamiMD H, MitsumuraMD H, IguchiMD Y. Infarct site and prognosis in small subcortical infarction: Role of the corticospinal tract and lentiform. J Neurol Sci 2020; 418:117130. [PMID: 32942191 DOI: 10.1016/j.jns.2020.117130] [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: 07/07/2020] [Revised: 08/25/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the impact of infarct site combinations on prognosis of small subcortical infarction (SSI) by classifying the infarcted perforator area in relation to the anatomical structures that surround and/or involve the corticospinal tract. METHODS Consecutive patients with SSI ≤24 h from onset to initial magnetic resonance imaging (MRI) and ≤ 14 days from onset to second MRI were included. Infarct sites were defined as follows: caudate head, lentiform (L), corona radiata (CR), posterior limb and genu of the internal capsule (IC), thalamus, and brainstem with or without involvement of the corticospinal tract. An unfavorable outcome was defined as a modified Rankin Scale score of 2 to 6 at 3 months from onset. Infarct site combinations related to an unfavorable outcome were evaluated. RESULTS We screened 1558 consecutive patients with ischemic strokes, including 128 with SSI (99 [77%] male, median age 64 years). Of all, 29 (23%) had unfavorable outcomes. Factors associated with unfavorable outcomes were age (odds ratio (OR) 2.057, 95% confidence interval (CI) 1.230-3.493, p = 0.006), maximum infarct area (OR 1.094, 95% CI 1.030-1.163, p = 0.004), and infarct simultaneously involving the CR, IC, and L (OR 9.403, 95% CI 1.506-58.710, p = 0.016). Patients with simultaneous involvement of the CR, IC, and L were likely to have a higher subscore in the National Institutes of Health Stroke Scale item of arm motor impairment at discharge (OR 2.947, 95% CI 1.098-7.910, p = 0.032). CONCLUSIONS Infarcts involving the CR, IC, and L predict unfavorable outcomes in SSI.
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Affiliation(s)
- Takeo SatoMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan.
| | - Kenichiro SakaiMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki TakatsuMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Maki TanabeMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Teppei KomatsuMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi SakutaMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Yuka TerasawaMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi UmeharaMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Shusaku OmotoMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Hidetomo MurakamiMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | | | - Yasuyuki IguchiMD
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
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Mostafa M, Abdel Naseer M, Edward R, Edrees M, Labib DM. Can diffusion tensor imaging lesion patterns predict the outcome of ischemic stroke? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Stroke can affect any portion of the central nervous system leading to a wide variety of symptoms depending on the part that is involved. Diffusion tensor imaging (DTI) is an emerging neuroimaging technique that allows measuring the integrity of white matter tracts.
Objectives
The objective of this study is to find out if the diffusion tensor tractography technique can provide prognostic information regarding clinical outcome following ischemic stroke.
Subjects and methods
Forty patients with acute ischemic stroke were studied with DTI. Size of infraction, degree of reduction of fractional anisotropy (FA), and pattern of corticospinal tract (CST) affection were identified. We assessed our patients according to the National Institute of Health Stroke Scale (NIHSS) and Medical Research Council (MRC) scale at onset of stroke and 3 months later.
Results
FA reduction was correlated with MRC and NIHSS on admission (P < 0.001, 0.004 respectively) and after 3 months (P < 0.001, 0.013 respectively). The pattern of CST affection was associated with NIHSS and MRC after 3 months (P = 0.035, 0.001 respectively).
Conclusion
DTI may be an indirect indicator of the ischemic stroke outcome.
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Can the integrity of the corticospinal tract predict the long-term motor outcome in poststroke hemiplegic patients? Neuroreport 2019; 29:453-458. [PMID: 29481524 DOI: 10.1097/wnr.0000000000000994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the long-term motor outcome according to early diffusion tensor tractography findings for the affected corticospinal tract (CST) in poststroke hemiplegic patients. A total of 48 supratentorial subacute patients after stroke were enrolled, who had a brain MRI scan within 6 weeks from onset, and no stroke recurrence reported within the 2-year follow-up period. Diffusion tensor images were obtained and CSTs were reconstructed. The participants were classified into three groups: type A, the CST originating from the primary motor cortex was preserved around the lesion area; type B, the CST was similar to type A, except that the fiber originated from the area adjacent to the primary motor cortex; and type C, the CST was interrupted or not shown. Motor functions using Fugl-Meyer Motor Assessment (FMA), the Box and Block Test (BBT), and Functional Ambulation Category, and cognitive function using Mini-Mental Status Examination (MMSE) were measured at baseline and at 2 years from stroke onset. Changes in FMA and BBT were significantly different according to diffusion tensor tractography type at follow-up (P<0.05), but Functional Ambulation Category and Mini-Mental Status Examination were not. In post-hoc analysis, groups A and B showed greater significant improvements on the BBT and on the upper FMA subscale (shoulder/elbow, wrist, and hand) compared with group C (corrected P<0.05), but did not on lower FMA. This study showed the importance of CST integrity for stoke motor recovery. The early integrity of the CST may be useful in predicting long-term motor outcomes, specifically with motor recovery of the upper extremity and hand function.
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Abdeldayem EH, Osman AM, Roushdy TM. Relative fractional anisotropy value using DTI: Can it help as a prognostic tool in anticipating the recovery of stroke patients? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kim B, Winstein C. Can Neurological Biomarkers of Brain Impairment Be Used to Predict Poststroke Motor Recovery? A Systematic Review. Neurorehabil Neural Repair 2016; 31:3-24. [PMID: 27503908 DOI: 10.1177/1545968316662708] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background There is growing interest to establish recovery biomarkers, especially neurological biomarkers, in order to develop new therapies and prediction models for the promotion of stroke rehabilitation and recovery. However, there is no consensus among the neurorehabilitation community about which biomarker(s) have the highest predictive value for motor recovery. Objective To review the evidence and determine which neurological biomarker(s) meet the high evidence quality criteria for use in predicting motor recovery. Methods We searched databases for prognostic neuroimaging/neurophysiological studies. Methodological quality of each study was assessed using a previously employed comprehensive 15-item rating system. Furthermore, we used the GRADE approach and ranked the overall evidence quality for each category of neurologic biomarker. Results Seventy-one articles met our inclusion criteria; 5 categories of neurologic biomarkers were identified: diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), functional magnetic resonance imaging (fMRI), conventional structural MRI (sMRI), and a combination of these biomarkers. Most studies were conducted with individuals after ischemic stroke in the acute and/or subacute stage (~70%). Less than one-third of the studies (21/71) were assessed with satisfactory methodological quality (80% or more of total quality score). Conventional structural MRI and the combination biomarker categories ranked "high" in overall evidence quality. Conclusions There were 3 prevalent methodological limitations: (a) lack of cross-validation, (b) lack of minimal clinically important difference (MCID) for motor outcomes, and (c) small sample size. More high-quality studies are needed to establish which neurological biomarkers are the best predictors of motor recovery after stroke. Finally, the quarter-century old methodological quality tool used here should be updated by inclusion of more contemporary methods and statistical approaches.
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Affiliation(s)
- Bokkyu Kim
- University of Southern California, Los Angeles, CA, USA
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Hong JS, Kim JM, Kim HS. Correlation between ambulatory function and clinical factors in hemiplegic patients with intact single lateral corticospinal tract: A pilot study. Medicine (Baltimore) 2016; 95:e4360. [PMID: 27495041 PMCID: PMC4979795 DOI: 10.1097/md.0000000000004360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To define the relationship between the complete destruction of 1 lateral corticospinal tract (CST), as demonstrated by diffusion tensor imaging (DTI) tractography, and ambulatory function 6 months following stroke.Twenty-six adults (17 male, 9 female) with poststroke hemiplegia who were transferred to the physical medicine and rehabilitation department. Participants underwent DTI tractography, which showed that 1 lateral CST had been clearly destroyed.Functional ambulation classification (FAC) scores at admission, discharge, and 6 months after discharge were used to evaluate the patients' ability to walk. The National Institutes of Health Stroke Scale (NIHSS) and the Korean version of the modified Barthel index (K-MBI) at admission, discharge, and 6 months after discharge were used to evaluate the degree of functional recovery.Of the 26 patients, 18 were nonambulatory (FAC level 1-3), and 8 were able to walk without support (FAC level 4-6). The type of stroke (infarction or hemorrhage), site of the lesion, spasticity of lower extremities, cranioplasty, and the time taken from onset to MRI were not statistically significantly correlated with the ability to walk. However, statistically significant correlations were found in relation to age, K-MBI scores, and initial NIHSS scores.Despite the complete damage to the lesion site and the preservation of 1 unilateral CST, as shown by DTI, good outcomes can be predicted on the basis of younger age, low NIHSS scores, and high MBI scores at onset.
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Affiliation(s)
| | | | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Correspondence: Hyoung Seop Kim, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, ilsan-donggu, Goyang, Korea, 10444 (e-mail: )
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Kim BR, Moon WJ, Kim H, Jung E, Lee J. Transcranial Magnetic Stimulation and Diffusion Tensor Tractography for Evaluating Ambulation after Stroke. J Stroke 2016; 18:220-6. [PMID: 27283282 PMCID: PMC4901949 DOI: 10.5853/jos.2015.01767] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the usefulness of combining transcranial magnetic stimulation (TMS) and diffusion tensor tractography (DTT) to evaluate corticospinal tract (CST) integrity and subsequently predict ambulatory function after middle cerebral artery (MCA) stroke. METHODS Forty-three patients with first MCA stroke underwent TMS and DTT to evaluate CST integrity. Patients were classified into four groups according to the presence of motor-evoked potentials (MEPs) obtained from the tibialis anterior muscle and CST integrity. Motor impairment and functional status were assessed using the Fugl-Meyer Assessment, Functional Ambulation Category, and Korean modified Barthel Index, both at the time of admission and after 4 weeks of rehabilitation. RESULTS Patients with the presence of both measurable MEPs and a preserved CST showed better motor recovery and ambulatory function than other groups at the 4-week follow-up. Intact CSTs were not visualized in patients without detectable MEPs. Among the patients displaying MEPs, those with preserved CSTs showed better recovery of paretic lower extremities. CONCLUSIONS Combined assessment using TMS and DTT to evaluate CST integrity confers advantages in predicting motor and ambulation recovery in patients with MCA stroke.
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Affiliation(s)
- Bo-Ram Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Hyuntae Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Eunhwa Jung
- Department of Rehabilitation Medicine, The Graduate School of Konkuk University and Konkuk University Medical Center, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
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Kumar P, Kathuria P, Nair P, Prasad K. Prediction of Upper Limb Motor Recovery after Subacute Ischemic Stroke Using Diffusion Tensor Imaging: A Systematic Review and Meta-Analysis. J Stroke 2016; 18:50-9. [PMID: 26846758 PMCID: PMC4747076 DOI: 10.5853/jos.2015.01186] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 12/10/2015] [Accepted: 12/10/2015] [Indexed: 10/30/2022] Open
Abstract
Early evaluation of the pyramidal tract using Diffusion Tensor Imaging (DTI) is a prerequisite to decide the optimal treatment or to assess appropriate rehabilitation. The early predictive value of DTI for assessing motor and functional recovery in ischemic stroke (IS) has yielded contradictory results. The purpose is to systematically review and summarize the current available literature on the value of Fractional Anisotropy (FA) parameter of the DTI in predicting upper limb motor recovery after sub-acute IS. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane CENTRAL searches were conducted from January 1, 1950, to July 31, 2015, which was supplemented with relevant articles identified in the references. Correlation between FA and upper limb motor recovery measure was done. Heterogeneity was examined using Higgins I-squared, Tau-squared. Summary of correlation coefficient was determined using Random Effects model. Out of 166 citations, only eleven studies met the criteria for inclusion in the systematic review and six studies were included in the meta-analysis. A random effects model revealed that DTI parameter FA is a significant predictor for upper limb motor recovery after sub-acute IS [Correlation Coefficient=0.82; 95% Confidence Interval-0.66 to 0.90, P value<0.001]. Moderate heterogeneity was observed (Tau-squared=0.12, I-squared=62.14). The studies reported so far on correlation between DTI and upper limb motor recovery are few with small sample sizes. This meta-analysis suggests strong correlation between DTI parameter FA and upper limb motor recovery. Well-designed prospective trials embedded with larger sample size are required to establish these findings.
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Affiliation(s)
- Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Prachi Kathuria
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pallavi Nair
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Elkholy SF, Khalil ME, Elbasmi AAE, Mahmoud BEMH, Edrees M. Diffusion tensor magnetic resonance imaging in assessment of prognostic outcome of stroke patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Kim KH, Kim YH, Kim MS, Park CH, Lee A, Chang WH. Prediction of Motor Recovery Using Diffusion Tensor Tractography in Supratentorial Stroke Patients With Severe Motor Involvement. Ann Rehabil Med 2015; 39:570-6. [PMID: 26361593 PMCID: PMC4564704 DOI: 10.5535/arm.2015.39.4.570] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/03/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate whether early stage diffusion tensor tractography (DTT) values predict motor function at 3 months after onset in supratentorial stroke patients with severe motor involvement. METHODS A retrospective study design was used to analyze medical records and neuroimaging data of 49 supratentorial stroke patients with severe motor involvement. Diffusion tensor imaging was assessed within 3 weeks after stroke in all patients. Three-dimensional tractography of the ipsilateral corticospinal tract (CST) was performed using the fiber assignment of the continuous tracking algorithm. The two-step DTT analysis was used. The first step was classification according to ipsilateral CST visualization. The second step was a quantitative analysis of the visible-CST group parameters. Motor function was assessed at 2 weeks and at 3 months after stroke. Comparative and correlation analyses were performed between DTT-derived measures and motor assessment scores. RESULTS Motor function of the upper extremity at 3 months after stroke was significantly higher in the visible-CST group than that in the nonvisible-CST group (p<0.05). Early stage fractional anisotropy was of DTT correlated significantly with upper extremity motor function at 3 months after stroke in the visible-CST group (p<0.05). CONCLUSION These results demonstrate that early DTT-derived measures predict motor recovery in the upper extremity at 3 months after onset in supratentorial stroke patients with severe motor involvement.
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Affiliation(s)
- Kang Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Chang-Hyun Park
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ahee Lee
- Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wang RR, Li C, Zhang S, Zhou LJ, He L, Li HD. Diffusion tensor imaging change in crus cerebri in striatocapsular infarction and correlation with upper extremity motor dysfunction. Radiol Med 2015; 120:1064-70. [PMID: 25835460 DOI: 10.1007/s11547-015-0534-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/20/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE There is limited information about the secondary changes in the pyramidal tract after some specific types of deep brain infarction including striatocapsular infarction. The aims of the current study were to investigate diffusion changes in the crus cerebri in patients with striatocapsular infarction using diffusion tensor imaging (DTI), and analyze the relationship between such changes and upper extremity motor dysfunction. MATERIALS AND METHODS Fifteen patients with acute onset of striatocapsular infarction and unilateral upper extremity motor dysfunction for the first time were studied prospectively. DTI was performed 2 weeks after disease onset, fractional anisotropy and mean diffusivity values of the bilateral crus cerebri were measured, the asymmetry indices of bilateral fractional anisotropy were calculated, and the relationship between the asymmetry index value and the Fugl-Meyer assessment score for the affected upper extremity function was evaluated. RESULTS Two weeks after disease onset, the fractional anisotropy value of the affected crus cerebri was reduced significantly compared with that of the unaffected crus cerebri (0.69 vs. 0.77; p < 0.001); there was no significant difference between bilateral mean diffusivity values. After correction for infarct size (448.93 ± 227.67 mm(2)) there was a negative correlation between the asymmetry index value and the Fugl-Meyer assessment score of the affected upper extremity (r = -0.78, p = 0.001). CONCLUSIONS DTI can detect the diffusion change in the crus cerebri in patients with striatocapsular infarction during the early stage of the disease and the integrity of the pyramidal tract in the crus cerebri is closely related to the motor function of the affected upper extremity.
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Affiliation(s)
- Run-Rong Wang
- Department of Radiology, Yangzhou First People's Hospital of Jiangsu Province, No. 45, Tai-Zhou Road, Yangzhou, 225000, Jiangsu, China
| | - Cheng Li
- Department of Radiology, Yangzhou First People's Hospital of Jiangsu Province, No. 45, Tai-Zhou Road, Yangzhou, 225000, Jiangsu, China.
| | - Shuai Zhang
- Department of Neurology, Yangzhou First People's Hospital of Jiangsu Province, Yangzhou, 225000, China
| | - Long-Jiang Zhou
- Department of Neurology, Yangzhou First People's Hospital of Jiangsu Province, Yangzhou, 225000, China
| | - Ling He
- Department of Radiology, Yangzhou First People's Hospital of Jiangsu Province, No. 45, Tai-Zhou Road, Yangzhou, 225000, Jiangsu, China
| | - Hua-Dong Li
- Department of Neurology, Yangzhou First People's Hospital of Jiangsu Province, Yangzhou, 225000, China
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Huang YC, Tsai YH, Lee JD, Weng HH, Lin LC, Lin YH, Wu CY, Huang YC, Hsu HL, Lee M, Yang HT, Hsu CY, Pan YT, Yang JT. Hemodynamic factors may play a critical role in neurological deterioration occurring within 72 hrs after lacunar stroke. PLoS One 2014; 9:e108395. [PMID: 25340713 PMCID: PMC4207695 DOI: 10.1371/journal.pone.0108395] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/21/2014] [Indexed: 11/23/2022] Open
Abstract
Background Whether a perfusion defect exists in lacunar infarct and whether it is related to early neurological deterioration (END) is still under debate. The aim of this study was to evaluate whether END in lacunar infarct is related to a perfusion defect using diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and perfusion MR imaging. Methods One hundred and forty-one consecutive patients had an MRI scan within 30 hours after onset of symptoms and 43 patients with acute lacunar infarct and classic lacunar syndrome were recruited. The MRI sequences included DWI, DTI and cerebral blood flow (CBF) maps to respectively represent the topographic locations of acute infarcts, the corticospinal tract and perfusion defects. The END was defined in reference to the National Institute of Health Stroke Scale (NIHSS) as an increase ≧2 within 72 hours. Cohen's Kappa coefficient was used to examine the reliability between the 2 image readers. A multivariate logistic regression model was constructed adjusting for baseline variables. Results Ten out of the 43 patients had END. Patients having END was significantly associated with lower chances of favorable and good outcomes at 3 months (p = 0.01 and p = 0.002, respectively). END was predicted when the non-core hypoperfused area overlapped on the corticospinal tract, which is defined as the expected END profile. Cohen's Kappa coefficient between the 2 image readers to define images of expected END profiles was 0.74. In 15 patients with expected END profile, 9 had END clinically, whereas 28 patients had no expected END profile, and only 1 patient had END (p<0.0001). After adjusting for sex, the expected END profile was still associated with END (odds ratio, 42.2; p = 0.002). Conclusion Our study demonstrated that the END in acute lacunar stroke is likely related to the transformation of non-core hypoperfused area into infarction in the anatomy of corticospinal tracts.
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Affiliation(s)
- Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi,Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi,Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Ya-Hui Lin
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Chih-Ying Wu
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Ying-Chih Huang
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Huan-Lin Hsu
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Hsin-Ta Yang
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Chia-Yu Hsu
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Yi-Ting Pan
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan
- * E-mail:
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Groisser BN, Copen WA, Singhal AB, Hirai KK, Schaechter JD. Corticospinal tract diffusion abnormalities early after stroke predict motor outcome. Neurorehabil Neural Repair 2014; 28:751-60. [PMID: 24519021 PMCID: PMC4128905 DOI: 10.1177/1545968314521896] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognosis of long-term motor outcome of acute stroke patients with severe motor impairment is difficult to determine. OBJECTIVE Our primary goal was to evaluate the prognostic value of corticospinal tract (CST) injury on motor outcome of the upper limb compared with motor impairment level and lesion volume. METHODS In all, 10 acute stroke patients with moderately severe to severe motor impairment of the upper limb underwent diffusion tensor imaging (DTI) and testing of upper limb strength and dexterity at acute, subacute, and chronic poststroke time points. A density-weighted CST atlas was constructed using DTI tractography data from normal participants. This CST atlas was applied, using a largely automated process, to DTI data from patients to quantify CST injury at each time point. Differences in axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) of the ipsilesional CST relative to the contralesional CST were measured. RESULTS Acute loss in CST AD correlated most strongly and significantly with subacute and chronic strength and dexterity and remained significant after adjusting for acute motor impairment or lesion volume. Subacute loss in CST FA correlated most strongly with chronic dexterity, whereas subacute behavioral measures of limb strength correlated most strongly with chronic strength measures. CONCLUSIONS Loss in acute CST AD and subacute CST FA are strong prognostic indicators of future motor functions of the upper limb for stroke patients with substantial initial motor impairment. DTI-derived measure of CST injury early after stroke may have utility in health care planning and in design of acute stroke clinical trials.
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Affiliation(s)
- Benjamin N Groisser
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William A Copen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kelsi K Hirai
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Judith D Schaechter
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hussain A, Utz MJ, Tian W, Liu X, Ekholm S. Imaging and Diseases of the Ascending and Descending Pathways. Semin Ultrasound CT MR 2014; 35:474-86. [DOI: 10.1053/j.sult.2014.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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17
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Corticospinal tract change during motor recovery in patients with medulla infarct: a diffusion tensor imaging study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:524096. [PMID: 24967374 PMCID: PMC4055626 DOI: 10.1155/2014/524096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022]
Abstract
Diffusion tensor imaging (DTI) and tractography (DTT) provide a powerful vehicle for investigating motor recovery mechanisms. However, little is known about these mechanisms in patients with medullary lesions. We used DTI and DTT to evaluate three patients presenting with motor deficits following unilateral medulla infarct. Patients were scanned three times during 1 month (within 7, 14, and 30 days after stroke onset). Fractional anisotropy (FA) values were measured in the medulla, cerebral peduncle, and internal capsule. The three-dimensional corticospinal tract (CST) was reconstructed using DTT. Patients 1 and 2 showed good motor recovery after 14 days, and the FA values of their affected CST were slightly decreased. DTTs demonstrated that the affected CST passed along periinfarct areas and that tract integrity was preserved in the medulla. Patient 3 had the most obvious decrease in FA values along the affected CST, with motor deficits of the right upper extremity after 30 days. The affected CST passed through the infarct and was disrupted in the medulla. In conclusion, DTI can detect the involvement and changes of the CST in patients with medulla infarct during motor recovery. The degree of degeneration and spared periinfarct CST compensation may be an important motor recovery mechanism.
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Rickards T, Sterling C, Taub E, Perkins-Hu C, Gauthier L, Graham M, Griffin A, Davis D, Mark VW, Uswatte G. Diffusion tensor imaging study of the response to constraint-induced movement therapy of children with hemiparetic cerebral palsy and adults with chronic stroke. Arch Phys Med Rehabil 2013; 95:506-514.e1. [PMID: 24055785 DOI: 10.1016/j.apmr.2013.08.245] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/19/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the relationship of white matter integrity and path of the corticospinal tract (CST) on arm function before and after constraint-induced (CI) movement therapy in children with hemiparetic cerebral palsy (CP) and adults with chronic stroke. DESIGN Study 1 used a multiple-baseline pre-post design. Study 2 was a randomized controlled trial. SETTING Outpatient rehabilitation laboratory. PARTICIPANTS Study 1 included children with hemiparetic CP (n=10; mean age ± SD, 3.2±1.7y). Study 2 included adults with chronic stroke (n=26; mean age ± SD, 65.4±13.6y) who received either CI therapy or a comparison therapy. INTERVENTIONS Children in study 1 received CI therapy for 3.5h/d for 15 consecutive weekdays. Adults in study 2 received either CI therapy or a comparison therapy for 3.5h/d for 10 consecutive weekdays. MAIN OUTCOME MEASURES Diffusion tensor imaging was performed to quantify white matter integrity. Motor ability was assessed in children using the Pediatric Motor Activity Log-Revised and Pediatric Arm Function Test, and in adults with the Motor Activity Log and Wolf Motor Function Test. RESULTS Participants in both studies improved in real-world arm function and motor capacity. Children and adults with disrupted/displaced CSTs and children with reduced fractional anisotropy values were worse on pretreatment tests of motor function than participants with unaltered CSTs. However, neither integrity (fractional anisotropy) nor distorted or disrupted path of the CST affected motor improvement after treatment. CONCLUSIONS Participants who had reduced integrity, displacement, or interruption of their CST performed worse on pretreatment motor testing. However, this had no effect on their ability to benefit from CI therapy. The results for children and adults are consistent with one another.
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Affiliation(s)
- Tyler Rickards
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Chelsey Sterling
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL.
| | | | - Lynne Gauthier
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH
| | - Michael Graham
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Angi Griffin
- Physical Therapy and Occupational Therapy Department, Children's of Alabama, Birmingham, AL
| | - Drew Davis
- Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Victor W Mark
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL; Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
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Ali GG, Elhameed AMA. Prediction of motor outcome in ischemic stroke involving the pyramidal tract using diffusion tensor imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2011.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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20
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Song F, Zhang F, Yin DZ, Hu YS, Fan MX, Ni HH, Nan XL, Cui X, Zhou CX, Huang CS, Zhao Q, Ma LH, Xu YM, Xia QJ. Diffusion Tensor Imaging for Predicting Hand Motor Outcome in Chronic Stroke Patients. J Int Med Res 2012; 40:126-33. [PMID: 22429352 DOI: 10.1177/147323001204000113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: Previous studies have indicated that diffusion tensor imaging (DTI) values are related to clinical outcome in stroke patients. This prospective study explored whether DTI values were predictive for hand function outcome in chronic stroke patients. METHODS: The DTI parameters (rλ1, rλ23, fractional anisotropy [rFA] and mean diffusivity [rMD]) were investigated in patients with completely paralysed hands (CPH; n = 10) or partially paralysed hands (PPH; n = 10), by two methods of analysis: segment of the corticospinal tract [sCST] analysis; pure region of interest [ROI] analysis. Spearman's correlation coefficient was used to assess the correlation between the DTI parameters and the following clinical measures: Fugl—Meyer Assessment [FMA]; National Institutes of Health Stroke Scale [NIHSS]. RESULTS: Significant differences were found between CPH and PPH for rFA and rλ23 (sCST analysis) and for rMD and rλ23 (ROI analysis). The rλ23 (sCST analysis) correlated with the NIHSS; the rMD (sCST analysis) correlated with the FMA (hand). CONCLUSION: The three parameters, rFA, rλ23 and rMD may have predictive value for evaluating hand function outcome in chronic stroke patients.
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Affiliation(s)
- F Song
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - F Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - D-Z Yin
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Y-S Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - M-X Fan
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - H-H Ni
- Department of Rehabilitation Medicine, Shanghai Tian Shan Chinese Traditional Medicine Hospital, Shanghai, China
| | - X-L Nan
- Department of Rehabilitation Medicine, Yonghe Branch of Shanghai Huashan Hospital, Shanghai, China
| | - X Cui
- Department of Rehabilitation Medicine, Shanghai Tian Shan Chinese Traditional Medicine Hospital, Shanghai, China
| | - C-X Zhou
- Department of Rehabilitation Medicine, Shanghai Tian Shan Chinese Traditional Medicine Hospital, Shanghai, China
| | - C-S Huang
- Department of Rehabilitation Medicine, Shanghai Tian Shan Chinese Traditional Medicine Hospital, Shanghai, China
| | - Q Zhao
- Department of Rehabilitation Medicine, Shanghai Tian Shan Chinese Traditional Medicine Hospital, Shanghai, China
| | - L-H Ma
- Department of Rehabilitation Medicine, Baoshan Branch of Shanghai Huashan Hospital, Shanghai, China
| | - Y-M Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Q-J Xia
- Department of Rehabilitation Medicine, Baoshan Branch of Shanghai Huashan Hospital, Shanghai, China
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Puig J, Pedraza S, Blasco G, Daunis-I-Estadella J, Prados F, Remollo S, Prats-Galino A, Soria G, Boada I, Castellanos M, Serena J. Acute damage to the posterior limb of the internal capsule on diffusion tensor tractography as an early imaging predictor of motor outcome after stroke. AJNR Am J Neuroradiol 2011; 32:857-63. [PMID: 21474629 DOI: 10.3174/ajnr.a2400] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early prediction of motor outcome is of interest in stroke management. We aimed to determine whether lesion location at DTT is predictive of motor outcome after acute stroke and whether this information improves the predictive accuracy of the clinical scores. MATERIALS AND METHODS We evaluated 60 consecutive patients within 12 hours of middle cerebral artery stroke onset. We used DTT to evaluate CST involvement in the motor cortex and premotor cortex, centrum semiovale, corona radiata, and PLIC and in combinations of these regions at admission, at day 3, and at day 30. Severity of limb weakness was assessed by using the motor subindex scores of the National Institutes of Health Stroke Scale (5a, 5b, 6a, 6b). We calculated volumes of infarct and fractional anisotropy values in the CST of the pons. RESULTS Acute damage to the PLIC was the best predictor associated with poor motor outcome, axonal damage, and clinical severity at admission (P < .001). There was no significant correlation between acute infarct volume and motor outcome at day 90 (P = .176, r = 0.485). The sensitivity, specificity, and positive and negative predictive values of acute CST involvement at the level of the PLIC for motor outcome at day 90 were 73.7%, 100%, 100%, and 89.1%, respectively. In the acute stage, DTT predicted motor outcome at day 90 better than the clinical scores (R(2) = 75.50, F = 80.09, P < .001). CONCLUSIONS In the acute setting, DTT is promising for stroke mapping to predict motor outcome. Acute CST damage at the level of the PLIC is a significant predictor of unfavorable motor outcome.
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Affiliation(s)
- J Puig
- Departments of Radiology, Girona Biomedical Research Institute, Hospital Universitari Dr. Josep Trueta, Spain.
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Ohara T, Yamamoto Y, Tamura A, Ishii R, Murai T. The infarct location predicts progressive motor deficits in patients with acute lacunar infarction in the lenticulostriate artery territory. J Neurol Sci 2010; 293:87-91. [DOI: 10.1016/j.jns.2010.02.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 02/25/2010] [Accepted: 02/26/2010] [Indexed: 11/30/2022]
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Liu X, Li L, Tian W, Zhao C, Dogra V. Quantitative diffusion tensor imaging for evaluation of motor function in patients with brain infarcts. Acta Neurol Scand 2010; 121:315-9. [PMID: 20047565 DOI: 10.1111/j.1600-0404.2009.01254.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the quantitative diffusion value in ipsilateral cerebral peduncle of patients with differing motor function abilities and analyse the thresholds discriminating the poor motor function disability. METHOD Twenty-nine patients who previously suffered stroke underwent diffusion tensor imaging examinations. Motor function was evaluated 8 months after the event. The ipsilateral apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of cerebral peduncle and ADC ratio and FA ratio of patients with different motor function scales were analysed. RESULTS The ipsilateral FA value and FA ratio were distinctly different in patients with different motor function scales, and significantly correlated with the motor function scales. There was no significant difference of ipsilateral ADC and ADC ratio, and neither had correlation with motor function scale. The patients with poor motor function scale could be discriminated by the cutoff value of ipsilateral FA of 0.453 and FA ratio of 0.623 with sensitivity of 90%, 75% and specificity of 88.9%, 88.9% respectively. CONCLUSIONS The ipsilateral FA value and FA ratio were feasible and better imaging indices in discriminating patients with poor motor function ability.
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Affiliation(s)
- Xiang Liu
- Department of Imaging Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642-8638, USA.
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Jang SH, Ahn SH, Sakong J, Byun WM, Choi BY, Chang CH, Bai D, Son SM. Comparison of TMS and DTT for predicting motor outcome in intracerebral hemorrhage. J Neurol Sci 2010; 290:107-11. [PMID: 19914639 DOI: 10.1016/j.jns.2009.10.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 10/16/2009] [Accepted: 10/21/2009] [Indexed: 11/24/2022]
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Tang PF, Ko YH, Luo ZA, Yeh FC, Chen SHA, Tseng WYI. Tract-specific and region of interest analysis of corticospinal tract integrity in subcortical ischemic stroke: reliability and correlation with motor function of affected lower extremity. AJNR Am J Neuroradiol 2010; 31:1023-30. [PMID: 20110374 DOI: 10.3174/ajnr.a1981] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE TS analysis has been suggested as a useful method to evaluate the fiber integrity of white matter tracts. This study investigated the intrarater and interrater reliability and validity of a TS analysis for the CST and compared the results with those of a ROI-based analysis. MATERIALS AND METHODS Diffusion spectrum imaging was performed on 7 patients with subcortical ischemic stroke on a 3T MR imaging system. For the TS analysis, seed regions were placed at the cerebral peduncle and the medial portion of the primary motor cortex to reconstruct the tracts of the CST for motor control of the lower extremity. The mean GFA was measured at the PLIC by calculating the weighted sum of the GFAs sampled by the CST tracts at this segment. For the ROI-based analysis, the posterior two-thirds of the PLIC were enclosed on the GFA maps, and the mean GFA in this ROI was calculated. RESULTS The results showed good-to-excellent intrarater and interrater reliability on the seed region/ROI placement (mean kappa values >0.80) and mean GFA values (ICCs >0.90) for both the TS and ROI-based analyses. Both the GFA(PLIC-TS) and GFA(PLIC-ROI) values were highly correlated with the motor function of the affected lower extremity (r = 0.76 and 0.80, respectively; P < .05). CONCLUSIONS We demonstrated good reliability and validity of the TS and ROI-based analyses of the CST corresponding to lower extremity motor control in patients with subcortical ischemic stroke.
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Affiliation(s)
- P-F Tang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Taipei, Taiwan, Republic of China
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Jang SH, Bai D, Son SM, Lee J, Kim DS, Sakong J, Kim DG, Yang DS. Motor outcome prediction using diffusion tensor tractography in pontine infarct. Ann Neurol 2008; 64:460-5. [PMID: 18661560 DOI: 10.1002/ana.21444] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated whether the integrity of the corticospinal tract classified by diffusion tensor tractography (DTT) can predict the motor outcome in 25 patients with pontine infarct. DTTs were obtained in the early stage of stroke (5-30 days) and were classified into two groups (type A: the integrity of corticospinal tract was preserved around the infarct; type B: corticospinal tract was interrupted). DTT type A patients showed better motor function than the type B patients at 6 months after onset. DTT obtained at the early stage of pontine infarct appears to have predictive value for motor outcome in patients with pontine infarct.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea.
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Abstract
Cell-based therapy for stroke represents a third wave of therapeutics for stroke and one focused on restorative processes with a longer time window of opportunity than neuroprotective therapies. An early time window, within the first week after stroke, is an opportunity for intravenously delivered bone marrow and perinatally derived cells that can home to areas of tissue injury and target brain remodeling. Allogeneic cells will likely be the most scalable and commercially viable product. Later time windows, months after stroke, may be opportunities for intracerebral transplantation of neuronally differentiated cell types. An integrated approach of cell-based therapy with early-phase clinical trials and continued preclinical work with focus on mechanisms of action is needed.
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Affiliation(s)
- David C Hess
- Department of Neurology, Medical College of Georgia, Augusta, GA 30912, USA.
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BJR review of the year — 2007. Br J Radiol 2008. [DOI: 10.1259/bjr/33020697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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