Koyama Tetsuo, Mochizuki Midori, Uchiyama Yuki, Domen Kazuhisa
Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, Japan.
Prog Rehabil Med. 2024 Jan 12;9:20240001. doi: 10.2490/prm.20240001. eCollection 2024.
The objective of this study was to evaluate the predictive precision of combining the corticospinal tract lesion load (CST-LL) with the diffusion-tensor fractional anisotropy of the corticospinal tract (CST-FA) in the lesioned hemispheres regarding motor outcomes.
Patients with putaminal and/or thalamic hemorrhage who had undergone computed tomography (CT) soon after onset in our hospital were retrospectively enrolled. The CST-LL was calculated after registration of the CT images to a standard brain. Diffusion-tensor imaging was performed during the second week after onset. Standardized automated tractography was employed to calculate the CST-FA. Outcomes were assessed at discharge from our affiliated rehabilitation facility using total scores of the motor component of the Stroke Impairment Assessment Set (SIAS-motor total; null to full, 0 to 25). Multivariate regression analysis was performed with CST-LL and CST-FA as explanatory variables and SIAS-motor total as a target value.
Twenty-five patients participated in this study. SIAS-motor total ranged from 0 to 25 (median, 17). CST-LL ranged from 0.298 to 7.595 (median, 2.522) mL, and the lesion-side CST-FA ranged from 0.211 to 0.530 (median, 0.409). Analysis revealed that both explanatory variables were detected as statistically significant contributory factors. The estimated t values indicated that the contributions of these two variables were almost equal. The obtained regression model accounted for 63.9% of the variability of the target value.
Incorporation of the CST-LL with the lesion-side CST-FA enhances the precision of the stroke outcome prediction model.
本研究的目的是评估将皮质脊髓束病变负荷（CST-LL）与病变半球皮质脊髓束的扩散张量分数各向异性（CST-FA）相结合对运动结局的预测精度。
回顾性纳入我院发病后不久接受计算机断层扫描（CT）的壳核和/或丘脑出血患者。将CT图像配准到标准脑模板后计算CST-LL。在发病后第二周进行扩散张量成像。采用标准化自动纤维束成像计算CST-FA。使用卒中损伤评估量表运动部分的总分（SIAS-运动总分；从零到满分，0至25分）在附属康复机构出院时评估结局。以CST-LL和CST-FA作为解释变量，SIAS-运动总分作为目标值进行多变量回归分析。
25例患者参与本研究。SIAS-运动总分范围为0至25分（中位数为17分）。CST-LL范围为0.298至7.595 mL（中位数为2.522 mL），病变侧CST-FA范围为0.211至0.530（中位数为0.409）。分析显示，两个解释变量均被检测为具有统计学意义的促成因素。估计的t值表明这两个变量的贡献几乎相等。所得回归模型解释了目标值63.9%的变异性。
将CST-LL与病变侧CST-FA相结合可提高卒中结局预测模型的精度。
