Moura Luciana M, Luccas Rafael, de Paiva Joselisa P Q, Amaro Edson, Leemans Alexander, Leite Claudia da C, Otaduy Maria C G, Conforto Adriana B
Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil.
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Front Neurol. 2019 May 8;10:445. doi: 10.3389/fneur.2019.00445. eCollection 2019.
Stroke is a leading cause of disability worldwide. Motor impairments occur in most of the patients with stroke in the acute phase and contribute substantially to disability. Diffusion tensor imaging (DTI) biomarkers such as fractional anisotropy (FA) measured at an early phase after stroke have emerged as potential predictors of motor recovery. In this narrative review, we: (1) review key concepts of diffusion MRI (dMRI); (2) present an overview of state-of-art methodological aspects of data collection, analysis and reporting; and (3) critically review challenges of DTI in stroke as well as results of studies that investigated the correlation between DTI metrics within the corticospinal tract and motor outcomes at different stages after stroke. We reviewed studies published between January, 2008 and December, 2018, that reported correlations between DTI metrics collected within the first 24 h (hyperacute), 2-7 days (acute), and >7-90 days (early subacute) after stroke. Nineteen studies were included. Our review shows that there is no consensus about gold standards for DTI data collection or processing. We found great methodological differences across studies that evaluated DTI metrics within the corticospinal tract. Despite heterogeneity in stroke lesions and analysis approaches, the majority of studies reported significant correlations between DTI biomarkers and motor impairments. It remains to be determined whether DTI results could enhance the predictive value of motor disability models based on clinical and neurophysiological variables.
中风是全球致残的主要原因。大多数中风患者在急性期会出现运动障碍，这在很大程度上导致了残疾。弥散张量成像（DTI）生物标志物，如中风后早期测量的分数各向异性（FA），已成为运动恢复的潜在预测指标。在这篇叙述性综述中，我们：（1）回顾扩散磁共振成像（dMRI）的关键概念；（2）概述数据收集、分析和报告的最新方法学方面；（3）批判性地审视DTI在中风中的挑战，以及研究皮质脊髓束内DTI指标与中风后不同阶段运动结果之间相关性的研究结果。我们回顾了2008年1月至2018年12月期间发表的研究，这些研究报告了中风后24小时内（超急性期）、2 - 7天（急性期）和>7 - 90天（早期亚急性期）收集的DTI指标之间的相关性。纳入了19项研究。我们的综述表明，关于DTI数据收集或处理的金标准尚无共识。我们发现，在评估皮质脊髓束内DTI指标的研究中，方法学存在很大差异。尽管中风病变和分析方法存在异质性，但大多数研究报告DTI生物标志物与运动障碍之间存在显著相关性。DTI结果是否能提高基于临床和神经生理学变量的运动残疾模型的预测价值，仍有待确定。
