Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany.
Hum Brain Mapp. 2024 Nov;45(16):e70060. doi: 10.1002/hbm.70060.
Structural disconnectome analyses have provided valuable insights into how a stroke lesion results in widespread network disturbances and how these relate to deficits, recovery patterns, and outcomes. Previous analyses have primarily focused on patients with relatively mild to moderate deficits. However, outcomes vary among survivors of severe strokes, and the mechanisms of recovery remain poorly understood. This study assesses the association between lesion-induced network disconnection and outcome after severe stroke. Thirty-eight ischaemic stroke patients underwent MRI brain imaging early after stroke and longitudinal clinical follow-up. Lesion information was integrated with normative connectome data to infer individual disconnectome profiles on a localized regional and region-to-region pathway level. Ordinal logistic regressions were computed to link disconnectome information to the modified Rankin Scale after 3-6 months. Disconnections of ipsilesional frontal, parietal, and temporal cortical brain areas were significantly associated with a worse motor outcome after a severe stroke, adjusted for the initial deficit, lesion volume, and age. The analysis of the underlying pathways mediating this association revealed location-specific results: For frontal, prefrontal, and temporal brain areas, the association was primarily driven by relatively sparse intrahemispheric disconnections. In contrast, the ipsilesional primary motor cortex, the dorsal premotor cortex, and various parietal brain regions showed a remarkable involvement of either frontoparietal intrahemispheric or additionally interhemispheric disconnections. These results indicate that localized disconnection of multiple regions embedded in the structural frontoparietal network correlates with worse outcomes after severe stroke. Specifically, primary motor and parietal cortices might gain particular importance as they structurally link frontoparietal networks of both hemispheres. These data shed novel light on the significance of distinct brain networks for recovery after a severe stroke.
结构性连接组学分析为理解中风损伤如何导致广泛的网络紊乱以及这些紊乱与缺陷、恢复模式和结果的关系提供了有价值的见解。以前的分析主要集中在轻度至中度缺陷的患者上。然而，严重中风幸存者的结果存在差异，恢复机制仍知之甚少。本研究评估了严重中风后病灶诱导的网络分离与结局之间的关系。38 例缺血性中风患者在中风后早期接受 MRI 脑部成像和纵向临床随访。将病灶信息与规范连接组数据整合，以推断个体局部区域和区域间通路水平的断开连接谱。计算有序逻辑回归，将断开连接信息与 3-6 个月后的改良 Rankin 量表联系起来。与严重中风后运动结局较差相关的同侧额、顶和颞皮质脑区的断开连接，在调整初始缺陷、病灶体积和年龄后，差异具有统计学意义。介导这种关联的潜在途径分析显示出特定的位置结果：对于额叶、前额叶和颞叶脑区，这种关联主要是由相对稀疏的半球内断开连接驱动的。相比之下，同侧初级运动皮层、背侧运动前皮层和各种顶叶脑区显示出显著的同侧额顶叶半球内或额外的半球间断开连接的参与。这些结果表明，结构性额顶叶网络中多个区域的局部断开连接与严重中风后的不良结局相关。具体来说，初级运动皮层和顶叶皮层可能具有重要意义，因为它们在结构上连接了两个半球的额顶叶网络。这些数据为严重中风后不同脑网络对恢复的重要性提供了新的认识。
