Diffusion Tensor Imaging for Predicting Hand Motor Outcome in Chronic Stroke Patients

Abstract

OBJECTIVE: Previous studies have indicated that diffusion tensor imaging (DTI) values are related to clinical outcome in stroke patients. This prospective study explored whether DTI values were predictive for hand function outcome in chronic stroke patients. METHODS: The DTI parameters (rλ₁, rλ₂₃, fractional anisotropy [rFA] and mean diffusivity [rMD]) were investigated in patients with completely paralysed hands (CPH; n = 10) or partially paralysed hands (PPH; n = 10), by two methods of analysis: segment of the corticospinal tract [sCST] analysis; pure region of interest [ROI] analysis. Spearman's correlation coefficient was used to assess the correlation between the DTI parameters and the following clinical measures: Fugl—Meyer Assessment [FMA]; National Institutes of Health Stroke Scale [NIHSS]. RESULTS: Significant differences were found between CPH and PPH for rFA and rλ₂₃ (sCST analysis) and for rMD and rλ₂₃ (ROI analysis). The rλ₂₃ (sCST analysis) correlated with the NIHSS; the rMD (sCST analysis) correlated with the FMA (hand). CONCLUSION: The three parameters, rFA, rλ₂₃ and rMD may have predictive value for evaluating hand function outcome in chronic stroke patients.

Keywords

Stroke Diffusion tensor imaging (DTI)Segment of the corticospinal tract (sCST) analysis Pure region of interest (ROI) analysis Hand function outcome

References

Dobkin

: Clinical practice. Rehabilitation after stroke. N Engl J Med 2005; 352: 1677–1684.

Clarke

Black

: Quality of life following stroke: negotiating disability, identity, and resources. J Appl Gerontol 2005; 24: 319–336.

Olsen

: Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke 1990; 21: 247–251.

Parker

Wade

Hewer

R Langton

: Loss of arm function after stroke: measurement, frequency, and recovery. Int Rehabil Med 1986; 8: 69–73.

Wade

Langton-Hewer

Wood

: The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry 1983; 46: 521–524.

Zhu

Lindenberg

Alexander

: Lesion load of the corticospinal tract predicts motor impairment in chronic stroke. Stroke 2010; 41: 910–915.

Lindenberg

Renga

Zhu

: Structural integrity of corticospinal motor fibers predicts motor impairment in chronic stroke. Neurology 2010; 74: 280–287.

van Kuijk

Pasman

Hendricks

: Predicting hand motor recovery in severe stroke: the role of motor evoked potentials in relation to early clinical assessment. Neurorehabil Neural Repair 2009; 23: 45–51.

Konishi

Yamada

Kizu

: MR tractography for the evaluation of functional recovery from lenticulostriate infarcts. Neurology 2005; 64: 108–113.

10.

Cho

Kim

Choi

: Motor outcome according to diffusion tensor tractography findings in the early stage of intracerebral hemorrhage. Neurosci Lett 2007; 421: 142–146.

11.

Cho

Kim

: Motor outcome according to the integrity of the corticospinal tract determined by diffusion tensor tractography in the early stage of corona radiata infarct. Neurosci Lett 2007; 426: 123–127.

12.

Lai

Zhang

Liu

: White matter tractography by diffusion tensor imaging plays an important role in prognosis estimation of acute lacunar infarctions. Br J Radiol 2007; 80: 782–789.

13.

Folstein

McHugh

“Mini-mental state“. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.

14.

van Wijck

Pandyan

Johnson

: Assessing motor deficits in neurological rehabilitation: patterns of instrument usage. Neurorehabil Neural Repair 2001; 15: 23–30.

15.

Brott

Adams

Jr Olinger

: Measurements of acute cerebral infarction: A clinical examination scale. Stroke 1989; 20: 864–870.

16.

Gillard

Papadakis

Martin

: MR diffusion tensor imaging of white matter tract disruption in stroke at 3 T. Br J Radiol 2001; 74: 642–647.

17.

Jang

Bai

Son

: Motor outcome prediction using diffusion tensor tractography in pontine infarct. Ann Neurol 2008; 64: 460–465.

18.

Jang

Cho

Kim

: Diffusion anisotrophy in the early stages of stroke can predict motor outcome. Restor Neurol Neurosci 2005; 23: 11–17.

19.

Chen

Zhang

: Evaluating ischemic stroke with diffusion tensor imaging. Neurol Res 2008; 30: 720–726.

20.

Pierpaoli

Barnett

Pajevic

: Water diffusion changes in Wallerian degeneration and their dependence on white matter architecture. Neuroimage 2001; 13: 1174–1185.

21.

Thomalla

Glauche

Koch

: Diffusion tensor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke. Neuroimage 2004; 22: 1767–1774.

22.

Thomalla

Glauche

Weiller

: Time course of Wallerian degeneration after ischaemic stroke revealed by diffusion tensor imaging. J Neurol Neurosurg Psychiatry 2005; 76: 266–268.

23.

Zhu

Zhang

: A longitudinal diffusion tensor imaging study on Wallerian degeneration of corticospinal tract after motor pathway stroke. Neuroimage 2009; 47: 451–458.

24.

Song

Sun

: Diffusion tensor imaging detects and differentiates axon and myelin degeneration in mouse optic nerve after retinal ischemia. Neuroimage 2003; 20: 1714–1722.

25.

Lindenberg

Zhu

Rüber

: Predicting functional motor potential in chronic stroke patients using diffusion tensor imaging. Hum Brain Mapp 2011; doi: 10.1002/hbm.21266 [epub ahead of print].

26.

Provenzale

Shah

Patel

: Systematic review of CT and MR perfusion imaging for assessment of acute cerebrovascular disease. AJNR Am J Neuroradiol 2008; 29: 1476–1482.

27.

Schaefer

Ozsunar

Assessing tissue viability with MR diffusion and perfusion imaging. AJNR Am J Neuroradiol 2003; 24: 436–443.