Motor Recovery Prediction With Clinical Assessment and Local Diffusion Homogeneity After Acute Subcortical Infarction

Abstract

Background and Purpose-Initial clinical assessment or conventional diffusion tensor imaging parameters alone do not reliably predict poststroke recovery of motor function. Recently, local diffusion homogeneity (LDH) has been proposed to represent the local coherence of water molecule diffusion and can serve as a complementary marker for investigating white matter alterations of the brain. We aimed to determine whether a combination of initial clinical assessment and LDH could predict motor recovery after acute subcortical infarction. Methods-Standard upper extremity Fugl-Meyer assessment and diffusion tensor imaging were performed 1, 4, and 12 weeks after onset in 50 patients with subcortical infarction. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Tract-based spatial statistics analysis was used to compare diffusion differences between proportional and poor recovery outcomes. Multivariate logistic regression model was used to identify the predictors of motor improvement within 12 weeks after stroke. Results-The poor recovery group had lower LDH than the proportional recovery group, mainly in the ipsilesional corticospinal tract in the superior corona radiate and posterior limb of internal capsule 1 week after stroke (P<0.005; family-wise error corrected). Multivariate logistic regression analysis indicated that both initial Fugl-Meyer assessment and LDH in the ipsilesional corticospinal tract in the superior corona radiate and posterior limb of internal capsule were predictors of motor improvement within 12 weeks after stroke (G=47.22; P<0.001). Leave-one-out cross-validation confirmed a positive predictive value of 0.818, a negative predictive value of 0.833, and an accuracy of 0.824 (P<0.00 001; permutation test). Conclusions-These

Local Diffusion Homogeneity Provides Supplementary Information in T2DM-Related WM Microstructural Abnormality Detection

“…To our best knowledge, this is the first study that comprehensively compare LDH and FA in a imaging-based clinical research, and the first study using LDH for DWI-based brain alteration detection in T2DM (American Diabetes, 2010; Liu et al, 2016, 2017; Zhuo et al, 2016). In this study, voxel-based intra-voxel (FA) and inter-voxel diffusivity metrics (LDH) were used in a whole-brain exploratory study to explore and compare their sensitivity in between-group comparison and brain-clinical association analysis.…”

“…Specifically, Kendall’s coefficient of concordance is used to quantify such an overall diffusivity similarity between a centered voxel and those of all its nearest neighborhood (Gong, 2013). For example, a higher LDH value may indicate local coherence enhancement of the fibers, possibly caused by changes in fiber myelination, diameter, or density (Gong, 2013; Liu et al, 2016, 2017).…”

Network change in the ipsilesional cerebellum is correlated with motor recovery following unilateral pontine infarction

“…The study protocol was planned as a 12‐week longitudinal investigation, with neurological assessment and acquisition of MRI data at three time points: during the first week after symptom onset (<7 days), at the end of the fourth week (28 ± 4 days) and at the end of the twelfth week (84 ± 4 days) . Control participants were scanned only once.…”

“…A motor deficit evaluation was performed at each time point after the stroke using the Fugl‐Meyer (FM) scale. Good recovery of motor function was defined according to a proportional recovery model residual value of <20 (Appendix S1) . According to the degree of motor recovery at the twelfth week after stroke, patients with stroke were further divided into better recovery (BR; FM score ≥95) and worse recovery (WR; FM score <95) subgroups.…”

Promoting post-stroke recovery through focal or whole body vibration: criticisms and prospects from a narrative review

“…Patients with cortical stroke are known to manifest worse baseline National Institute of Health Scale/Score (i.e., stroke severity) on average than patients with subcortical lesions. Conversely, a single subcortical white matter damage would result in cortical differentiation causing widespread cortical dysfunction or severe motor impairment and poor motor recovery [63,64]. Hence, when evaluating the effect of fMV/WBV on post-stroke recovery, it should be taken into account that the efficacy would depend on the specific pattern of brain damage [62].…”