From the Department of Neurology and Stroke Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L., S.T., C.D., S.X., J.Z.); and State Key Laboratory of Oncology in Southern China, Imaging Diagnosis and Interventional Center, Cancer Center of Sun Yat-sen University, Guangzhou, China (K.P., C.X.).
Stroke. 2017 Aug;48(8):2121-2128. doi: 10.1161/STROKEAHA.117.017060. Epub 2017 Jun 19.
Initial clinical assessment or conventional diffusion tensor imaging parameters alone do not reliably predict poststroke recovery of motor function. Recently, local diffusion homogeneity (LDH) has been proposed to represent the local coherence of water molecule diffusion and can serve as a complementary marker for investigating white matter alterations of the brain. We aimed to determine whether a combination of initial clinical assessment and LDH could predict motor recovery after acute subcortical infarction.
Standard upper extremity Fugl-Meyer assessment and diffusion tensor imaging were performed 1, 4, and 12 weeks after onset in 50 patients with subcortical infarction. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Tract-based spatial statistics analysis was used to compare diffusion differences between proportional and poor recovery outcomes. Multivariate logistic regression model was used to identify the predictors of motor improvement within 12 weeks after stroke.
The poor recovery group had lower LDH than the proportional recovery group, mainly in the ipsilesional corticospinal tract in the superior corona radiate and posterior limb of internal capsule 1 week after stroke (<0.005; family-wise error corrected). Multivariate logistic regression analysis indicated that both initial Fugl-Meyer assessment and LDH in the ipsilesional corticospinal tract in the superior corona radiate and posterior limb of internal capsule were predictors of motor improvement within 12 weeks after stroke (G=47.22; <0.001). Leave-one-out cross-validation confirmed a positive predictive value of 0.818, a negative predictive value of 0.833, and an accuracy of 0.824 (<0.00 001; permutation test).
These results suggest that a combination of clinical assessment and LDH in the ipsilesional corticospinal tract in the acute phase can accurately predict resolution of upper limb impairment within 12 weeks after subcortical infarction.
初始临床评估或常规弥散张量成像参数并不能可靠地预测卒中后运动功能的恢复。最近，局部弥散均匀性（LDH）已被提出，以代表水分子弥散的局部一致性，可作为研究脑白质改变的补充标志物。我们旨在确定初始临床评估与 LDH 的结合是否能预测急性皮质下梗死后的运动功能恢复。
50 例皮质下梗死患者在发病后第 1、4 和 12 周分别进行标准上肢 Fugl-Meyer 评估和弥散张量成像。采用比例恢复模型残差将患者分为比例恢复组和不良恢复组。基于束的空间统计分析用于比较比例恢复和不良恢复结果之间的弥散差异。多变量逻辑回归模型用于识别卒中后 12 周内运动改善的预测因子。
不良恢复组 LDH 低于比例恢复组，主要位于病变对侧皮质脊髓束的 superior corona radiate 和 posterior limb of internal capsule，在卒中后 1 周时差异有统计学意义（<0.005；经家族-wise 错误校正）。多变量逻辑回归分析表明，初始 Fugl-Meyer 评估和病变对侧皮质脊髓束的 superior corona radiate 和 posterior limb of internal capsule 的 LDH 均是卒中后 12 周内运动改善的预测因子（G=47.22；<0.001）。留一法交叉验证证实阳性预测值为 0.818，阴性预测值为 0.833，准确性为 0.824（<0.00001；置换检验）。
这些结果表明，在急性期病变对侧皮质脊髓束的临床评估与 LDH 的结合可以准确预测皮质下梗死后 12 周内上肢运动障碍的缓解。
