Li Yuanhao, Yan Su, Zhang Guiling, Shen Nanxi, Wu Di, Lu Jun, Zhou Yiran, Liu Yufei, Zhu Hongquan, Li Li, Zhang Shun, Zhu Wenzhen
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Magn Reson Imaging. 2022 Apr;55(4):1171-1180. doi: 10.1002/jmri.27911. Epub 2021 Sep 6.
Corticospinal tract (CST) injury has been shown to exert a major influence on functional recovery after ischemic stroke.
To evaluate the prognostic value of CST injury estimated using a recent developed tractometry-based method.
Prospective.
Forty-eight patients with CST damage induced by stroke lesion who underwent brain magnetic resonance imaging within 7 days from onset.
Diffusion-weighted imaging (b = 1000 seconds/mm ) and diffusion kurtosis imaging (DKI) spin-echo echo-planar sequence with three b-values (0, 1250, and 2500 seconds/mm ) at 3.0 T.
A recently developed approach that combines tract segmentation and orientation mapping was used for CST-specific tractography and tractometry. CST injury was estimated using the proposed method with diffusion metrics extracted from DKI sequence and with the first principal component (PC1) of the metrics. We also calculated the weighted lesion load (wLL) for comparison. Clinical evaluation included the National Institutes of Health Stroke Score in the acute phase and the modified Rankin scale at 3 months post-stroke. The correlations between CST injury and initial motor impairment, as well as the prognostic values of CST injury for functional outcomes were evaluated.
Pearson correlation and logistic regression. Area under the receiver operating characteristic curve. P < 0.05 was considered statistically significant.
CST injury calculated with diffusion metrics except fractional anisotropy all showed significant correlations with initial motor impairment. PC1 achieved the largest correlation coefficient (R = 0.65) compared with wLL and other diffusion metrics. In addition to wLL, DKI_AK, AFD_total, and PC1 maximum all showed predictive values for functional outcomes.
Structural injury to CST is important for the assessment of the extent of injury and the prediction of functional outcome. The method proposed in our study could provide an imaging indicator to quantify the CST injury after ischemic stroke.
2 TECHNICAL EFFICACY: Stage 1.
皮质脊髓束（CST）损伤已被证明对缺血性中风后的功能恢复有重大影响。
评估使用最近开发的基于纤维束成像的方法估计的CST损伤的预后价值。
前瞻性研究。
48例因中风病灶导致CST损伤且在发病7天内接受脑磁共振成像检查的患者。
在3.0T下采用扩散加权成像（b = 1000秒/毫米²）和具有三个b值（0、1250和2500秒/毫米²）的扩散峰度成像（DKI）自旋回波平面回波序列。
采用一种最近开发的结合纤维束分割和方向映射的方法进行CST特异性纤维束成像和纤维束测量。使用从DKI序列提取的扩散指标和指标的第一主成分（PC1），通过所提出的方法估计CST损伤。我们还计算了加权病变负荷（wLL）以作比较。临床评估包括急性期的美国国立卫生研究院卒中量表和中风后3个月的改良Rankin量表。评估CST损伤与初始运动障碍之间的相关性，以及CST损伤对功能结局的预后价值。
Pearson相关性分析和逻辑回归分析。受试者操作特征曲线下面积。P < 0.05被认为具有统计学意义。
除各向异性分数外，用扩散指标计算的CST损伤均与初始运动障碍显示出显著相关性。与wLL和其他扩散指标相比，PC1的相关系数最大（R = 0.65）。除wLL外，DKI_AK、AFD_total和PC1最大值均显示出对功能结局的预测价值。
CST的结构损伤对于评估损伤程度和预测功能结局很重要。我们研究中提出的方法可为量化缺血性中风后CST损伤提供一种影像学指标。
2 技术疗效：1级。
