Bigourdan Antoine, Munsch Fanny, Coupé Pierrick, Guttmann Charles R G, Sagnier Sharmila, Renou Pauline, Debruxelles Sabrina, Poli Mathilde, Dousset Vincent, Sibon Igor, Tourdias Thomas
From the Université de Bordeaux, Bordeaux, France (A.B., F.M., P.C., C.R.G.G., V.D., I.S., T.T.); CHU de Bordeaux, Neuroimagerie Diagnostique et Thérapeutique, Bordeaux, France (A.B., F.M., V.D., T.T.); INSERM, U1215, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); LaBRI, UMR 5800, PICTURA, Talence, France (P.C.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.G.); CHU de Bordeaux, Unité Neurovasculaire, Bordeaux, France (S.S., P.R., S.D., M.P., I.S.); and INCIA, UMR 5287, Bordeaux, France (I.S.).
Stroke. 2016 Apr;47(4):1053-9. doi: 10.1161/STROKEAHA.115.011576. Epub 2016 Mar 15.
The contribution of imaging metrics to predict poststroke motor recovery needs to be clarified. We tested the added value of early diffusion tensor imaging (DTI) of the corticospinal tract toward predicting long-term motor recovery.
One hundred seventeen patients were prospectively assessed at 24 to 72 hours and 1 year after ischemic stroke with diffusion tensor imaging and motor scores (Fugl-Meyer). The initial fiber number ratio (iFNr) and final fiber number ratio were computed as the number of streamlines along the affected corticospinal tract normalized to the unaffected side and were compared with each other. The prediction of motor recovery (ΔFugl-Meyer) was first modeled using initial Fugl-Meyer and iFNr. Multivariate ordinal logistic regression models were also used to study the association of iFNr, initial Fugl-Meyer, age, and stroke volume with Fugl-Meyer at 1 year.
The iFNr correlated with the final fiber number ratio at 1 year (r=0.70; P<0.0001). The initial Fugl-Meyer strongly predicted motor recovery (≈73% of initial impairment) for all patients except those with initial severe stroke (Fugl-Meyer<50). For these severe patients (n=26), initial Fugl-Meyer was not correlated with motor recovery (R(2)=0.13; p=ns), whereas iFNr showed strong correlation (R(2)=0.56; P<0.0001). In multivariate analysis, the iFNr was an independent predictor of motor outcome (β=2.601; 95% confidence interval=0.304-5.110; P=0.031), improving prediction compared with using only initial Fugl-Meyer, age, and stroke volume (P=0.026).
Early measurement of FNr at 24 to 72 hours poststroke is a surrogate marker of corticospinal tract integrity and provides independent prediction of motor outcome at 1 year especially for patients with severe initial impairment.
影像指标对预测卒中后运动恢复的作用有待明确。我们测试了皮质脊髓束早期弥散张量成像（DTI）对预测长期运动恢复的附加价值。
对117例缺血性卒中患者在发病24至72小时及1年后进行前瞻性评估，采用弥散张量成像和运动评分（Fugl-Meyer）。计算初始纤维数量比（iFNr）和最终纤维数量比，即沿患侧皮质脊髓束的流线数量相对于健侧进行归一化处理后的比值，并对二者进行比较。首先使用初始Fugl-Meyer和iFNr对运动恢复（Fugl-Meyer评分变化值）进行建模。多变量有序逻辑回归模型也用于研究iFNr、初始Fugl-Meyer、年龄和卒中体积与1年后Fugl-Meyer评分之间的关联。
iFNr与1年后的最终纤维数量比相关（r = 0.70；P < 0.0001）。除初始严重卒中（Fugl-Meyer评分<50）患者外，初始Fugl-Meyer评分能强烈预测所有患者的运动恢复情况（约占初始损伤的73%）。对于这些严重患者（n = 26），初始Fugl-Meyer评分与运动恢复无相关性（R² = 0.13；p = 无统计学意义），而iFNr显示出强相关性（R² = 0.56；P < 0.0001）。在多变量分析中，iFNr是运动结局的独立预测指标（β = 2.601；95%置信区间 = 0.304 - 5.110；P = 0.031），与仅使用初始Fugl-Meyer评分、年龄和卒中体积相比，能改善预测效果（P = 0.026）。
卒中后24至72小时早期测量纤维数量比是皮质脊髓束完整性的替代指标，尤其对于初始损伤严重的患者，可独立预测1年后的运动结局。
