Chen Yung-Chieh, Cheng Sho-Jen, Hsieh Li-Chun, Shyu Hann-Yeh, Chen Ming-Hua, Chen Cheng-Yu, Kuo Duen-Pang
Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.
Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
Top Stroke Rehabil. 2024 Mar;31(2):199-210. doi: 10.1080/10749357.2023.2214977. Epub 2023 May 20.
Diffusion tensor imaging (DTI) biomarkers can be used to quantify microstructural changes in the cerebral white matter (WM) following injury.
This prospective single-center study aimed to evaluate whether atlas-based DTI-derived metrics obtained within 1 week after stroke can predict the motor outcome at 3 months.
Forty patients with small acute stroke (2-7 days after onset) involving the corticospinal tract were included. Each patient underwent magnetic resonance imaging (MRI) within 1 week and at 3 months after stroke, and the changes based on DTI-derived metrics were compared by performing WM tract atlas-based quantitative analysis.
A total of 40 patients were included, with median age 63.5 years and a majority of males (72.5%). Patients were classified into good-prognosis group (mRS 0-2, = 27) and poor-prognosis group (mRS 3-5, = 13) by outcome. The median (25-75 percentile) of MD (0.7 (0.6-0.7) vs. 0.7 (0.7-0.8); = 0.049) and AD (0.6 (0.5, 0.7) vs. 0.7 (0.6, 0.8); = 0.023) ratios within 1 week were significantly lower in the poor-prognosis group compared to the good-prognosis group. The ROC curve of the combined DTI-derived metrics model showed comparable Youden index (65.5% vs. 58.4%-65.4%) and higher specificity (96.3% vs. 69.2%-88.5%) compared to clinical indexes. The area under the ROC curve of the combined DTI-derived metrics model is comparable to those of the clinical indexes (all > 0.1) and higher than those of the individual DTI-derived metrics parameters.
Atlas-based DTI-derived metrics at acute stage provide objective information for prognosis prediction of patients with ischemic or lacunar stroke.
弥散张量成像（DTI）生物标志物可用于量化脑白质（WM）损伤后的微观结构变化。
这项前瞻性单中心研究旨在评估卒中后1周内基于图谱的DTI衍生指标是否能够预测3个月时的运动结局。
纳入40例累及皮质脊髓束的急性小卒中患者（发病后2 - 7天）。每位患者在卒中后1周内及3个月时接受磁共振成像（MRI）检查，并通过基于WM束图谱的定量分析比较基于DTI衍生指标的变化。
共纳入40例患者，中位年龄63.5岁，大多数为男性（72.5%）。根据结局将患者分为预后良好组（改良Rankin量表评分0 - 2分，n = 27）和预后不良组（改良Rankin量表评分3 - 5分，n = 13）。预后不良组1周内平均弥散率（MD）（0.7（0.6 - 0.7）对0.7（0.7 - 0.8）；P = 0.049）和轴向弥散率（AD）（0.6（0.5，0.7）对0.7（0.6，0.8）；P = 0.023）的中位数（第25 - 75百分位数）显著低于预后良好组。与临床指标相比，联合DTI衍生指标模型的ROC曲线显示出相当的约登指数（65.5%对58.4% - 65.4%）和更高的特异性（96.3%对69.2% - 88.5%）。联合DTI衍生指标模型的ROC曲线下面积与临床指标相当（均>0.1）且高于单个DTI衍生指标参数。
急性期基于图谱的DTI衍生指标为缺血性或腔隙性卒中患者的预后预测提供了客观信息。
