Zavaglia Melissa, Forkert Nils D, Cheng Bastian, Gerloff Christian, Thomalla Götz, Hilgetag Claus C
Department of Computational Neuroscience, University Medical Center Eppendorf, Hamburg University, Martinistraße 52, Hamburg 20246, Germany ; School of Engineering and Science, Jacobs University Bremen, Campus Ring 1, Bremen 28759, Germany.
Department of Computational Neuroscience, University Medical Center Eppendorf, Hamburg University, Martinistraße 52, Hamburg 20246, Germany ; Department of Radiology, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
Neuroimage Clin. 2015 Aug 1;9:83-94. doi: 10.1016/j.nicl.2015.07.009. eCollection 2015.
Lesion analysis reveals causal contributions of brain regions to mental functions, aiding the understanding of normal brain function as well as rehabilitation of brain-damaged patients. We applied a novel lesion inference technique based on game theory, Multi-perturbation Shapley value Analysis (MSA), to a large clinical lesion dataset. We used MSA to analyze the lesion patterns of 148 acute stroke patients together with their neurological deficits, as assessed by the National Institutes of Health Stroke Scale (NIHSS). The results revealed regional functional contributions to essential behavioral and cognitive functions as reflected in the NIHSS, particularly by subcortical structures. There were also side specific differences of functional contributions between the right and left hemispheric brain regions which may reflect the dominance of the left hemispheric syndrome aphasia in the NIHSS. Comparison of MSA to established lesion inference methods demonstrated the feasibility of the approach for analyzing clinical data and indicated its capability for objectively inferring functional contributions from multiple injured, potentially interacting sites, at the cost of having to predict the outcome of unknown lesion configurations. The analysis of regional functional contributions to neurological symptoms measured by the NIHSS contributes to the interpretation of this widely used standardized stroke scale in clinical practice as well as clinical trials and provides a first approximation of a 'map of stroke'.
病灶分析揭示了脑区对心理功能的因果贡献，有助于理解正常脑功能以及脑损伤患者的康复。我们将一种基于博弈论的新型病灶推断技术——多扰动夏普利值分析（MSA）应用于一个大型临床病灶数据集。我们使用MSA分析了148例急性中风患者的病灶模式及其神经功能缺损情况，神经功能缺损情况由美国国立卫生研究院卒中量表（NIHSS）评估。结果揭示了NIHSS所反映的对基本行为和认知功能的区域功能贡献，特别是皮层下结构的贡献。左右半球脑区在功能贡献方面也存在侧别差异，这可能反映了NIHSS中左半球综合征失语症的优势地位。将MSA与已有的病灶推断方法进行比较，证明了该方法分析临床数据的可行性，并表明其能够从多个受损的、可能相互作用的部位客观推断功能贡献，代价是必须预测未知病灶组合的结果。对NIHSS所测量的神经症状的区域功能贡献分析，有助于在临床实践以及临床试验中解释这一广泛使用的标准化中风量表，并提供了一个“中风图谱”的初步近似。
