Background/Aim: It remains unclear how wallerian degeneration of the pyramidal tract (PT) in the acute phase of supratentorial intracranial hemorrhage (ICH) correlates with the long-term functional outcome. The aim of this study was to quantify and predict the long-term neuromotor outcome using diffusion tensor imaging (DTI) during the early stages of ICH. Methods: Twenty-seven patients with a hemiparetic ICH were prospectively studied using DTI either within 3 days or at 2 weeks after onset. A region-of-interest-based analysis was performed for fractional anisotropy (FA) of the PT in the cerebral peduncle. The degree of paresis was assessed upon admission and at 6 months using paresis grading (PG), and the functional outcome was evaluated using the modified Rankin Scale (mRS). The activities of daily living were evaluated using the Functional Independence Measure (FIM). Results: The FA values within 3 days and after 2 weeks of ICH onset were significantly decreased at the affected side (p = 0.001, reduced by 11%; p < 0.001, reduced by 14%, respectively), but the mean diffusivity at the same time points remained unchanged (p = 0.05 and p = 0.136, respectively). The ratio of the FA (rFA) at the affected side to that of the unaffected side within 3 days was negatively correlated with the PG (p < 0.001, r = –0.642), positively correlated with the FIM scores (p = 0.004, r = 0.532), and negatively correlated with the mRS scores at the end of follow-up (median = 17 months) (p = 0.010, r = –0.490). The rFA at 2 weeks was positively correlated with the FIM (p < 0.001, r = 0.661) and negatively correlated with mRS scores and PG at the end of follow-up (p < 0.001, r = –0.653; p < 0.001, r = –0.700). For both patients with good and poor outcomes based on the PG, the area under the receiver operating characteristic (ROC) curve for rFA at 2 weeks was greater than the area under the ROC for rFA within 3 days, and the cutoff point for the rFA at 2 weeks was set at 0.875 (sensitivity 76%, specificity 89%). Conclusions: This study demonstrated that the use of DTI during the early stages of ICH may predict motor outcomes at 6 months after ICH. Moreover, as compared to use of DTI within 3 days of ICH onset, the application of DTI at 2 weeks after ICH could more accurately predict the motor outcomes and daily living activities of patients.

Crossed cerebellar diaschisis (CCD) has been widely investigated in patients with supratentorial stroke. However, the role of CCD in lower limb recovery after stroke is still unknown. In this study, using a region-of-interest-based analysis of diffusion tensor imaging (DTI), a total of 44 cases of stroke within 3 months onset were enrolled for assessment of the cerebral peduncle (CP) and middle cerebellar peduncles (MCP) in CCD. Compared with the control group, the fractional anisotropy ratio (rFA) and laterality index (LI) of the CP and MCP in the stroke group significantly decreased. The rFA of the MCP (unaffected side/affected side) showed a more significant correlation with 1-year paresis grading (PG), lower extremity PG, upper extremity PG, National Institutes of Health Stroke Scale (NIHSS), and functional independence measure (FIM) motor item score, in comparison to the rFA of the CP (affected side/unaffected side) (r = −0.698 vs. r = −0.541, r = −0.651 vs. r = −0.386, r = −0.642 vs. r = −0.565, r = −0.519 vs. r = −0.403, and r = 0.487 vs. r = 0.435, respectively). Furthermore, the LI of the CP had a more significant association with 1-year Brunel Balance Assessment (BBA), upper extremity PG, and Modified Rankin Scale (mRS) as compared to the LI of the MCP (r = 0.573 vs. r = 0.452; r = −0.554 vs. r = −0.528; and r = −0.494 vs. r = −0.344, respectively). We set the cutoff point for the MCP rFA at 0.925 (sensitivity: 79% and specificity: 100%) for predicting lower extremity motor function prognosis and found the receiver operating characteristic (ROC) curve of MCP rFA was larger than that of CP rFA (0.893 vs. 0.737). These results reveal that the MCP may play a significant role in the recovery of walking ability after stroke.