Clinicotopographical Correlation of Corticospinal Tract Stroke

Abstract

Background-Small capsular strokes are difficult to assess with regard to the precise location and the extent of pyramidal tract damage with conventional brain imaging. Color-coded diffusion tensor imaging (CDTI) provides a means to visualize the course of the corticospinal tract within the white matter. In addition to T 2 -weighted MRI, diffusionweighted MRI and CDTI were used to analyze the topographical patterns of small lacunar corticospinal tract strokes. Methods-We examined 15 patients with pyramidal tract strokes in the subacute phase (days 3 to 7). Lesions were identified on diffusion-weighted MRI and superimposed on CDTI images. The anatomic location and pattern of the lesion were visualized on CDTI with regard to the corticospinal tract and subsequently compared with the clinical presentation. In addition, infarct areas were evaluated with quantitative parameters: mean diffusivity and lattice anisotropy index of lesions were determined. Results-We identified 5 different patterns of corticospinal tract stroke falling into 2 clinical subgroups: (1) those with marked deficits and minor improvement (6/15) and (2) those with good recovery (9/15). Group 1 had long lesions centered in the pyramidal tract, involving the basal ganglia (anterior choroidal artery); group 2 lesions were very small and/or located anteriorly and medially (periventricular anterior choroidal artery territory; thalamogeniculate, tuberothalamic, and lateral striate branches). Lesions showed a significant increase of mean diffusivity and decrease of lattice anisotropy. Conclusion-CDTI allows in vivo differentiation of distinct subcortical stroke subtypes. Improved anatomic definition of lesion localization using CDTI may help in better establishing the prognosis for patients after subcortical stroke.

Granulocyte colony-stimulating factor for acute ischemic stroke: a randomized controlled trial

“…The entire examination procedure was the same as that described in a previous study. 18 The patient was supported on a wooden cradle, and his or her head was placed in a human head coil with an outer diameter of 5 cm. After the acquisition of scout images, 6-8 coronal plane images were taken between 3 mm behind the olfactory bulb and the caudal portion of the cerebellum.…”

Diffusion Tensor Pyramidal Tractography in Patients With Anterior Choroidal Artery Infarcts

“…Mean values of FA and ADC in stroke lesions and healthy tissue of homologous brain structures of the unaffected hemisphere were determined as described previously 7 with a region of interest size of 5 ϫ 5 voxels. All of the measurements were performed at the level of the largest stroke extents.…”

“…The extent of tissue destruction, on the other hand, can be extrapolated from parameters such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) reduction. 6,7 DTT can also quantify potential CST injury on a voxel-by-voxel basis by detecting asymmetries in comparison with the healthy side ("fiber ratio" [FR]) in a region of interest-independent approach. In this study, we focused on DTT as a possible quantitative parameter to assess the motor outcome in AchoA stroke.…”

Multimodal MRI of Cerebral Small Vessel Disease

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