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Astrakas LG, Li S, Elbach S, Tzika AA. The Severity of Sensorimotor Tracts Degeneration May Predict Motor Performance in Chronic Stroke Patients, While Brain Structural Network Dysfunction May Not. Front Neurol 2022; 13:813763. [PMID: 35432180 PMCID: PMC9008887 DOI: 10.3389/fneur.2022.813763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Although the relationship between corticospinal tract (CST) fiber degeneration and motor outcome after stroke has been established, the relationship of sensorimotor cortical areas with CST fibers has not been clarified. Also limited research has been conducted on how abnormalities in brain structural networks are related to motor recovery. To address these gaps in knowledge, we conducted a diffusion tensor imaging (DTI) study with 12 chronic stroke patients (CSPs) and 12 age-matched healthy controls (HCs). We compared fractional anisotropy (FA) and mean diffusivity (MD) in 60 CST segments using the probabilistic sensorimotor area tract template (SMATT). Least Absolute Shrinkage and Selection Operator (LASSO) regressions were used to select independent predictors of Fugl-Meyer upper extremity (FM-UE) scores among FA and MD values of SMATT regions. The Graph Theoretical Network Analysis Toolbox was used to assess the structural network of each subject's brain. Global and nodal metrics were calculated, compared between the groups, and correlated with FM-UE scores. Mann–Whitney U-tests revealed reduced FA values in CSPs, compared to HCs, in many ipsilesional SMATT regions and in two contralesional regions. Mean FA value of the left (L.) primary motor cortex (M1)/supplementary motor area (SMA) region was predictive of FM-UE score (P = 0.004). Mean MD values for the L. M1/ventral premotor cortex (PMv) region (P = 0.001) and L. PMv/SMA region (P = 0.001) were found to be significant predictors of FM-UE scores. Network efficiency was the only global metric found to be reduced in CSPs (P = 0.006 vs. HCs). Nodal efficiency of the L. hippocampus, L. parahippocampal gyrus, L. fusiform gyrus (P = 0.001), and nodal local efficiency of the L. supramarginal gyrus (P < 0.001) were reduced in CSPs relative to HCs. No graph metric was associated with FM-UE scores. In conclusion, the integrity of CSTs connected to M1, SMA, and PMv were shown to be independent predictors of motor performance in CSPs, while stroke-induced topological changes in the brain's structural connectome may not be. A sensorimotor cortex-specific tract template can refine CST degeneration data and the relationship of CST degeneration with motor performance.
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Affiliation(s)
- Loukas G. Astrakas
- Department of Medical Physics, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Shasha Li
- Department of Radiology, Athinoula A. Martinos Center of Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sabrina Elbach
- Department of Radiology, Athinoula A. Martinos Center of Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - A. Aria Tzika
- Department of Radiology, Athinoula A. Martinos Center of Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: A. Aria Tzika
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Srisaikaew P, Wongpakaran N, Anderson ND, Chen JJ, Kothan S, Varnado P, Unsrisong K, Mahakkanukrauh P. Fornix Integrity Is Differently Associated With Cognition in Healthy Aging and Non-amnestic Mild Cognitive Impairment: A Pilot Diffusion Tensor Imaging Study in Thai Older Adults. Front Aging Neurosci 2020; 12:594002. [PMID: 33343334 PMCID: PMC7745667 DOI: 10.3389/fnagi.2020.594002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
Damage to the fornix leads to significant memory impairment and executive dysfunction and is associated with dementia risk. We sought to identify if fornix integrity and fiber length are disrupted in mild cognitive impairment (MCI) and how they associate with cognition. Data from 14 healthy older adult controls (HCs) and 17 subjects with non-amnestic MCI (n-aMCI) were analyzed. Diffusion tensor imaging (DTI) at 1.5 Tesla MRI was performed to enable manual tracing of the fornix and calculation of DTI parameters. Higher fractional anisotropy of body and column of the fornix was associated with better executive functioning and memory, more strongly in the HC than in the n-aMCI group. Fornix fiber tract length (FTL) was associated with better executive function, more strongly in the n-aMCI than in the HC group, and with better memory, more strongly in the HC than in the n-aMCI group. These results highlight a decline in the contributions of the fornix to cognition in n-aMCI and suggest that maintenance of fornix FTL is essential for sustaining executive functioning in people with n-aMCI.
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Affiliation(s)
- Patcharaporn Srisaikaew
- Ph.D. Program in Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nahathai Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nicole D. Anderson
- Rotman Research Institute, Baycrest Health Science, Toronto, ON, Canada
- Department of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J. Jean Chen
- Rotman Research Institute, Baycrest Health Science, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Suchart Kothan
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Pairada Varnado
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittisak Unsrisong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Excellence in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, Thailand
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Microstructural characterization of corticospinal tract in subacute and chronic stroke patients with distal lesions by means of advanced diffusion MRI. Neuroradiology 2019; 61:1033-1045. [PMID: 31263922 PMCID: PMC6689031 DOI: 10.1007/s00234-019-02249-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of the paper is to evaluate if advanced dMRI techniques, including diffusion kurtosis imaging (DKI) and neurite orientation dispersion and density imaging (NODDI), could provide novel insights into the subtle microarchitectural modifications occurring in the corticospinal tract (CST) of stroke patients in subacute and chronic phases. METHODS Seventeen subjects (age 68 ± 11 years) in the subacute phase (14 ± 3 days post-stroke), 10 of whom rescanned in the chronic phase (231 ± 36 days post-stroke), were enrolled. Images were acquired using a 3-T MRI scanner with a two-shell EPI protocol (20 gradient directions, b = 700 s/mm2, 3 b = 0; 64 gradient directions, b = 2000 s/mm2, 9 b = 0). DTI-, DKI-, and NODDI-derived parameters were calculated in the posterior limb of the internal capsule (PLIC) and in the cerebral peduncle (CP). RESULTS In the subacute phase, a reduction of FA, AD, and KA values was correlated with an increase of ODI, RD, and AK parameters, in both the ipsilesional PLIC and CP, suggesting that increased fiber dispersion can be the main structural factor. In the chronic phase, a reduction of FA and an increase of ODI persisted in the ipsilesional areas. This was associated with reduced Fic and increased MD, with a concomitant reduction of MK and increase of RD, suggesting that fiber reduction, possibly due to nerve degeneration, could play an important role. CONCLUSIONS This study shows that advanced dMRI approaches can help elucidate the underpinning architectural modifications occurring in the CST after stroke. Further follow-up studies on bigger cohorts are needed to evaluate if DKI- and NODDI-derived parameters might be proposed as complementary biomarkers of brain microstructural alterations.
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Hodgson K, Adluru G, Richards LG, Majersik JJ, Stoddard G, Adluru N, DiBella E. Predicting Motor Outcomes in Stroke Patients Using Diffusion Spectrum MRI Microstructural Measures. Front Neurol 2019; 10:72. [PMID: 30833925 PMCID: PMC6387951 DOI: 10.3389/fneur.2019.00072] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 01/18/2019] [Indexed: 12/29/2022] Open
Abstract
Improved understanding of neuroimaging signal changes and their relation to patient outcomes after ischemic stroke is needed to improve ability to predict motor improvement and make therapy recommendations. The posterior limb of the internal capsule (PLIC) is a hub of afferent and efferent motor signaling and this work proposes new, image-based methods for prognosis based on interhemispheric differences in the PLIC. In this work, nine acute supratentorial ischemic stroke patients with motor impairment received a baseline, 203-direction diffusion brain MRI and a clinical assessment 3–12 days post-stroke and were compared to nine age-matched healthy controls. Asymmetries based on the mean and Kullback-Leibler divergence in the ipsilesional and contralesional PLIC were calculated for diffusion tensor imaging (DTI) and diffusion spectrum imaging (DSI) measures from the baseline MRI. Predictions of upper extremity Fugl-Meyer (FM) scores at 5-weeks follow-up from baseline measures of PLIC asymmetry in diffusion tensor imaging (DTI) and diffusion spectrum imaging (DSI) models were evaluated. For the stroke participants, the baseline asymmetry measures in the PLIC for the orientation dispersion index of the neurite orientation dispersion and density imaging (NODDI) model were highly correlated with upper extremity FM outcomes (r2 = 0.83). Use of DSI and the NODDI orientation dispersion index parameter shows promise of being more predictive of stroke recovery and to help better understand white matter changes in stroke, beyond DTI measures. The new finding that baseline interhemispheric differences in the PLIC calculated from the orientation dispersion index of the NODDI model are highly correlated with upper extremity functional outcomes may lead to improved image-based motor-outcome prediction after middle cerebral artery ischemic stroke.
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Affiliation(s)
- Kyler Hodgson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Ganesh Adluru
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, United States
| | - Lorie G Richards
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, United States
| | - Jennifer J Majersik
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Greg Stoddard
- Divison of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Nagesh Adluru
- Waisman Center, University of Wisconsin, Madison, WI, United States
| | - Edward DiBella
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, United States
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Zhang ZY, Liu ZQ, Qin W, Chen YW, Liu ZJ. Clinical and Radiological Features of Wallerian Degeneration of the Middle Cerebellar Peduncles Secondary to Pontine Infarction. Chin Med J (Engl) 2018. [PMID: 29521288 PMCID: PMC5865311 DOI: 10.4103/0366-6999.226890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Wallerian degeneration (WD) of bilateral middle cerebellar peduncles (MCPs) can occur following pontine infarction, but its characteristics have not yet been clarified because of the low incidence. Thus, the present study discussed the clinical and radiological features to improve the awareness of this disease. Methods: Clinical and radiological information from consecutive individuals diagnosed with WD of bilateral MCPs following pontine infarction in three hospitals over the past 4 years between October 2012 and October 2016 were retrospectively investigated and compared with a control group (patients with pontine infarction had no secondary WD). Results: This study involved 30 patients with WD of MCPs, with a detection rate of only 4.9%. The primary infarctions (χ2 =24.791, P = 0.001, vs. control group) were located in the paramedian pons in 21 cases (70.0%), and ventrolateral pons in nine cases (30.0%). WD of the MCPs was detected 8–24 weeks after pons infarction using conventional magnetic resonance imaging (MRI); all secondary WDs were asymptomatic and detected incidentally. All WD lesions exhibited bilateral, symmetrical, and boundary blurring on MRI. The signal features were hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging and fluid-attenuated inversion recovery, and slightly hyperintense or isointense on diffusion-weighted imaging and apparent diffusion coefficient maps. Secondary brainstem atrophy was found in six (20.0%) cases. A Modified Rankin Scale score 0–2 was found in 10 (33.3%) cases and score >2 in 20 (66.7%) cases at 90 days after discharge, and the short-term prognosis was worse than that in control group (χ2 =12.814, P = 0.001). Conclusions: Despite the rarity of bilateral and symmetrical lesions of MCPs, secondary WD should be highly suspected if these lesions occur within 6 months after pontine infarction, particularly paramedian pons. Conventional MRI appears to be a relatively sensitive method for detecting WD of MCPs, which might affect the short-term prognosis.
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Affiliation(s)
- Zhi-Yong Zhang
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhi-Qin Liu
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710003, China
| | - Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Ya-Wen Chen
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zun-Jing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
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Tu MC, Huang WH, Hsu YH, Lo CP, Deng JF, Huang CF. Comparison of neuropsychiatric symptoms and diffusion tensor imaging correlates among patients with subcortical ischemic vascular disease and Alzheimer's disease. BMC Neurol 2017; 17:144. [PMID: 28754095 PMCID: PMC5534111 DOI: 10.1186/s12883-017-0911-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/05/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The causes of behavioral and psychological symptoms of dementia (BPSD) vary according to the dementia subtype and associated neuropathology. The present study aimed to (i) compare BPSD between patients with subcortical ischemic vascular disease (SIVD) and Alzheimer's disease (AD) across stages, and (ii) explore the associations with diffusion tensor imaging (DTI) in the corpus callosum (CC) and other major fibers. METHODS Twenty-four patients with SIVD and 32 with AD were recruited. Four domains of the Neuropsychiatric Inventory (NPI) (hyperactivity, psychosis, affective, and apathy) and two DTI parameters [fractional anisotropy (FA) and mean diffusivity (MD)] within the genu, body (BCC), and splenium (SCC) of the CC and other major fibers were assessed. RESULTS Overall, the patients with clinical dementia rating (CDR) 1 ~ 2 had higher scores in apathy domain than those with CDR0.5. Among those with CDR1 ~ 2, SIVD had higher scores in apathy domain than AD. MD values in the BCC/SCC were positively correlated with total NPI score and psychosis, hyperactivity, and apathy domains. FA values in the SCC were inversely correlated with total NPI score and psychosis domain. The correlations were modified by age, the CASI, and CDR scores. Stepwise linear regression models suggested that FA value within the left superior longitudinal fasciculus predicted the hyperactivity domain. MD value within the SCC/left uncinate fasciculus and FA value within the GCC/left forceps major predicted the psychosis domain. MD value within the right superior longitudinal fasciculus and CDR predicted the apathy domain. Further analysis suggested distinct patterns of regression models between SIVD and AD patients. CONCLUSION White matter integrity within the BCC/SCC had associations with multi-domains of BPSD. Our study also identified important roles of regions other than the CC to individual domain of BPSD, including the left superior longitudinal fasciculus to the hyperactivity domain, the left uncinate fasciculus/forceps major to the psychosis domain, and the right superior longitudinal fasciculus to the apathy domain. The neuronal substrates in predicting BPSD were different between SIVD and AD patients. Of note, apathy, which was more profound in SIVD, was associated with corresponding fiber disconnection in line with dementia severity and global cognition decline.
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Affiliation(s)
- Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Hui Huang
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Chung-Ping Lo
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Radiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Jie Fu Deng
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
| | - Ching-Feng Huang
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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