Functional connectivity (FC) studies have identified physiological signatures of stroke that correlate with behavior. Using structural and functional MRI data from 114 stroke patients, 24 matched controls, and the Human Connectome Project, we tested the hypothesis that structural disconnection, not damage to critical regions, underlies FC disruptions. Disconnection severity outperformed damage to putative FC connector nodes for explaining reductions in system modularity, and multivariate models based on disconnection outperformed damage models for explaining FC disruptions within and between systems. Across patients, disconnection and FC patterns exhibited a lowdimensional covariance dominated by a single axis linking interhemispheric disconnections to reductions in FC measures of interhemispheric system integration, ipsilesional system segregation, and system modularity, and that correlated with multiple behavioral deficits. These findings clarify the structural basis of FC disruptions in stroke patients and demonstrate a low-dimensional link between perturbations of the structural connectome, disruptions of the functional connectome, and behavioral deficits.
Stroke disrupts system-scale functional connectivityResting-state fMRI data were used to measure FC between 324 cortical parcels associated with different brain systems ( Fig. 2A-C). We defined twelve system-scale summary measures to capture reductions of interhemispheric system integration, ipsilesional system segregation, and system modularity. For each patient, we extracted the mean interhemispheric FC values for nine bilateral cortical systems (Fig. 2D, left) and averaged across systems to summarize interhemispheric system integration across the cortex (Fig. 2D, left inset). We also extracted the mean FC between the ipsilesional DAN and DMN to quantify ipsilesional system segregation (Fig. 2D, middle), and we averaged modularity estimates for a priori system partitions across multiple edge density thresholds to summarize overall network structure ( Fig. 2D, right; mean shown in inset).The mean FC matrices for patients and controls had similar topographies ( Fig. 2B; r=0.96, p<0.001), but subtracting the patient matrix from the control matrix revealed magnitude differences that were often in opposite directions for connections with positive vs. negative values in the mean control matrix (Fig. 2C; r=-0.42, p<0.001), consistent with reduced integration within systems and reduced segregation between systems in patients. As expected, patients showed marked abnormalities in FC summary measures of interhemispheric integration, ipsilesional segregation, and system modularity (Fig. 2D). These measures were used as dependent variables in subsequent analyses.