Loubinoux Isabelle, Lafuma Marie, Rigal Julien, Colitti Nina, Albucher Jean-François, Raposo Nicolas, Planton Mélanie, Olivot Jean-Marc, Chollet François
Toulouse NeuroImaging Center (ToNIC), Toulouse, France.
Neurology Department, Toulouse, France.
J Neurol. 2024 Oct;271(10):6876-6887. doi: 10.1007/s00415-024-12648-y. Epub 2024 Sep 3.
Clinical factors are not sufficient to fix a prognosis of recovery after stroke. Pyramidal tract or alternate motor fiber (aMF: reticulo-, rubrospinal pathways and transcallosal fibers) integrity and remodeling processes assessable by diffusion tensor MRI (DTI) and voxel-based morphometry (VBM) may be of interest. The primary objective was to study longitudinal cortical brain changes using VBM and longitudinal corticospinal tract changes using DTI during the first 4 months after lacunar cerebral infarction. The second objective was to determine which changes were correlated to clinical improvement.
Twenty-one patients with deep brain ischemic infarct with pure motor deficit (NIHSS score ≥ 2) were recruited at Purpan Hospital and included. Motor deficit was measured [Nine peg hole test (NPHT), dynamometer (DYN), Hand-Tapping Test (HTT)], and a 3T MRI scan (VBM and DTI) was performed during the acute and subacute phases.
White matter changes: corticospinal fractional anisotropy (FA) was significantly reduced at follow-up (approximately 4 months) on the lesion side. FAr (FA ratio in affected/unaffected hemispheres) in the corona radiata was correlated to the motor performance at the NPHT, DYN, and HTT at follow-up. The presence of aMFs was not associated with the extent of recovery. Grey matter changes: VBM showed significant increased cortical thickness in the ipsilesional premotor cortex at follow-up. VBM changes in the anterior cingulum positively correlated with improvement in motor measures between baseline and follow-up.
To our knowledge, this study is original because is a longitudinal study combining VBM and DTI during the first 4 months after stroke in a series of patients selected on pure motor deficit. Our data would suggest that good recovery relies on spared CST fibers, probably from the premotor cortex, rather than on the aMF in this group with mild motor deficit. The present study suggests that VBM and FA could provide reliable biomarkers of post-stroke atrophy, reorganization, plasticity and recovery.
NCT01862172, registered May 24, 2013.
临床因素不足以确定卒中后的恢复预后。通过扩散张量磁共振成像（DTI）和基于体素的形态学测量（VBM）评估的锥体束或替代运动纤维（aMF：网状、红核脊髓束和胼胝体下纤维）完整性及重塑过程可能具有研究价值。主要目的是在腔隙性脑梗死发病后的前4个月，利用VBM研究大脑皮质的纵向变化，并利用DTI研究皮质脊髓束的纵向变化。第二个目的是确定哪些变化与临床改善相关。
在普尔潘医院招募并纳入了21例患有深部脑缺血性梗死且伴有单纯运动功能缺损（美国国立卫生研究院卒中量表评分≥2分）的患者。测量运动功能缺损情况[九点针孔试验（NPHT）、握力计（DYN）、手部敲击试验（HTT）]，并在急性期和亚急性期进行3T磁共振成像扫描（VBM和DTI）。
白质变化：随访时（约4个月），病变侧皮质脊髓束的分数各向异性（FA）显著降低。放射冠中的FAr（患侧/健侧半球的FA比值）与随访时NPHT、DYN和HTT的运动表现相关。aMFs的存在与恢复程度无关。灰质变化：VBM显示随访时患侧运动前皮质的皮质厚度显著增加。前扣带回的VBM变化与基线至随访期间运动测量指标的改善呈正相关。
据我们所知，本研究具有创新性，因为它是一项针对一系列因单纯运动功能缺损入选的患者，在卒中后的前4个月将VBM和DTI相结合的纵向研究。我们的数据表明，良好的恢复依赖于可能来自运动前皮质的保留的皮质脊髓束纤维，而非该轻度运动功能缺损组中的aMF。本研究表明，VBM和FA可为卒中后萎缩、重组、可塑性和恢复提供可靠的生物标志物。
NCT01862172，于2013年5月24日注册。
