From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China.
Neurology. 2020 Sep 1;95(9):e1174-e1187. doi: 10.1212/WNL.0000000000010149. Epub 2020 Jun 25.
To elucidate the timeframe and spatial patterns of cortical reorganization after different stroke-induced basal ganglia lesions, we measured cortical thickness at 5 time points over a 6-month period. We hypothesized that cortical reorganization would occur very early and that, along with motor recovery, it would vary based on the stroke lesion site.
Thirty-three patients with unilateral basal ganglia stroke and 23 healthy control participants underwent MRI scanning and behavioral testing. To further decrease heterogeneity, we split patients into 2 groups according to whether or not the lesions mainly affect the striatal motor network as defined by resting-state functional connectivity. A priori measures included cortical thickness and motor outcome, as assessed with the Fugl-Meyer scale.
Within 14 days poststroke, cortical thickness already increased in widespread brain areas ( = 0.001), mostly in the frontal and temporal cortices rather than in the motor cortex. Critically, the 2 groups differed in the severity of motor symptoms ( = 0.03) as well as in the cerebral reorganization they exhibited over a period of 6 months (Dice overlap index = 0.16). Specifically, the frontal and temporal regions demonstrating cortical thickening showed minimal overlap between these 2 groups, indicating different patterns of reorganization.
Our findings underline the importance of assessing patients early and of considering individual differences, as patterns of cortical reorganization differ substantially depending on the precise location of damage and occur very soon after stroke. A better understanding of the macrostructural brain changes following stroke and their relationship with recovery may inform individualized treatment strategies.
为了阐明不同基底节卒中引起的基底节损伤后皮质重组的时间框架和空间模式，我们在 6 个月的时间内测量了 5 个时间点的皮质厚度。我们假设皮质重组会很早就发生，并且会随着运动功能的恢复而变化，这取决于卒中病变部位。
33 例单侧基底节卒中患者和 23 名健康对照者接受了 MRI 扫描和行为测试。为了进一步降低异质性，我们根据病变是否主要影响静息状态功能连接定义的纹状体运动网络，将患者分为 2 组。预先测量的指标包括皮质厚度和运动结果，用 Fugl-Meyer 量表评估。
卒中后 14 天内，皮质厚度已经在广泛的脑区增加（ = 0.001），主要在前额和颞叶皮质，而不是运动皮质。关键的是，这 2 组在运动症状的严重程度（ = 0.03）以及在 6 个月期间表现出的大脑重组方面存在差异（Dice 重叠指数 = 0.16）。具体来说，表现出皮质增厚的额颞叶区域在这 2 组之间几乎没有重叠，表明了不同的重组模式。
我们的发现强调了早期评估患者和考虑个体差异的重要性，因为皮质重组的模式因损伤的确切位置而异，并且在卒中后很快就会发生。更好地了解卒中后大脑的宏观结构变化及其与恢复的关系可能为个体化治疗策略提供信息。
