Prediction of Motor Recovery after Stroke by Assessment of Corticospinal Tract Wallerian Degeneration Using Diffusion Tensor Imaging

Abstract

Aim of the Study To predict motor recovery after stroke by detection of diffusion tensor imaging (DTI) fractional anisotropy (FA) changes of corticospinal tract (CST) and correlate findings with clinical scores to provide more effective treatment and rehabilitation. Subjects and Methods Thirty patients with cerebral stroke were enrolled and underwent conventional magnetic resonance imaging and DTI at admission and 1 month after stroke. Mean diffusivity (MD), FA, FA ratio (rFA), and fiber number (FN) values of CST were calculated at the pons at admission and after 1 month of stroke. Three-dimensional reconstruction of bilateral CST and the structural changes of fibrous bands were observed. Severity of limb weakness was assessed by using the motor sub-index scores of the National Institutes of Health Stroke Scale (NIHSS) at admission, and after 1, 6, and 9 months for severity of limb weakness. Results The mean age of our patients was 61.32 ± 4.34 years, 17/30 (56.6%) were females, and 13/30 (43.4%) were males. In our study, 18/30 (60%) were hypertensive, 19/30 (63.3%) were diabetic, and 12/30 (40%) were smokers. A significant negative correlation was found between rFA and FN in the ipsilateral CST of the cerebral infarction at the rostral part of pons after 1 month of infarction and NIHSS score at 6 months (r = 0.377, p = 0.04 and r = 0.237, p = 0.02, respectively). However, a positive insignificant correlation was found between MD and NIHSS (r = 0.345, p = 0.635). The initial NIHSS score at the time of injury was 19.2 ± 4.3, which changed to 7.9 ± 2.4, 4.6 ± 1.9, and 3.3 ± 1.4 at 1, 6, and 9 months, respectively. Conclusion DTI is a sensitive tool for early detection of Wallerian degeneration in the CST after stroke, and can predict motor performance to provide effective treatment and rehabilitation to improve quality of life.

Diffusion Tensor Imaging as a Prognostic Tool for Recovery in Acute and Hyperacute Stroke

“…One study does did provide information regarding field strength [ 30 ]. With regards to the number of directions, three studies used 6 directions (two in 1.5 T [ 34 , 35 ] and one in 3.0 T [ 36 ]), eight studies used 12 directions (four in 1.5 T [ 37 , 38 , 39 ] and four in 3.0 T [ 40 , 41 , 42 , 43 ]), three studies used 15 directions (two in 1.5 T [ 44 , 45 ] and one in 3.0 T [ 23 ]), three studies used 16 directions (one in 1.5 T [ 46 ] and two in 3.0 T [ 24 , 47 ]), one study in 1.5 T used 20 directions [ 31 ], one study in 3.0 T used 25 directions [ 48 ], eight studies used 30 directions (two in 1.5 T [ 49 , 50 ] and six in 3.0 T [ 18 , 29 , 33 , 51 , 52 , 53 ]), three studies in 1.5 T used 32 directions [ 54 , 55 , 56 ], one study in 3.0 T used 55 directions [ 57 ], and seven studies in 3.0 T used 64 directions [ 25 , 26 , 27 , 32 , 58 , 59 , 60 ]). Six studies did not provide information regarding diffusion directions.…”

“…Similarly, Shaheen and colleagues [ 38 ] studied 45 middle cerebral artery (MCA) stroke patients and 17 controls and demonstrated that baseline FA and rFA were negatively associated with the NIHSS and Modified Rankin Score (mRS) and positively associated with Motricity Index (MI). In contrast to the aforementioned studies where DTI metrics at acute phase were predictive of outcome, Darwish and colleagues [ 54 ] examined 30 patients who underwent DTI on admission and 1 month post-stroke and found significant negative correlation between rFA at the rostral pons 1 month post-stroke and NIHSS score at 6 months. These findings also applied to FN in the CST ipsilateral to infarct.…”

Exploring the Structural Plasticity Mechanism of Corticospinal Tract during Stroke Rehabilitation Based Automated Fiber Quantification Tractography

“…23-25 Previous studies have found that both anterograde and retrograde Wallerian degeneration can occur in fiber bundles around ischemic stroke lesions, and DTI is a common method for evaluating Wallerian degeneration, with changes in FA and other parameter values reflecting white matter demyelination and axonal damage. 26,27 Doughty et al 28 found a significant decrease in the FA values of the CST around the lesion 80 hours after the onset of ischemic stroke, while the FA values of the cerebral peduncles distal to the lesion did not change significantly. This suggested that Wallerian degeneration of the white matter around the lesion is most pronounced during the early stages, and it may take some time for Wallerian degeneration to progress distally.…”

Protective effects of human urinary kallidinogenase against corticospinal tract damage in acute ischemic stroke patients

“…Stroke is a leading cause of adult disability, and motor deficits are common after stroke (82% of patients), despite incredible progress and advancements in stroke management [1]. Acute ischemic stroke (AIS) is a common type of stroke with a high morbidity and disability rate [2][3][4][5]. AIS patients with corticospinal tract injury can endure severe limb paralysis that seriously affects their quality of life.…”

“…The apparent diffusion coefficient (ADC) is the average of the degree of diffusion of water molecules in all directions [23]. Pathophysiological changes in the early stage of cerebral infarction can cause changes in DTI parameters which can predict and evaluate motor function after cerebral infarction [5].…”