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Ann Neurol. 2015 Dec;78(6):860-70. doi: 10.1002/ana.24510. Epub 2015 Oct 31.

Corticospinal tract lesion load: An imaging biomarker for stroke motor outcomes.

Author information

1
Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, SC.
2
Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC.
3
Neuroimaging & Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
4
Section on Biomarkers and Prediction Modeling, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
5
Ralph H. Johnson VA Medical Center, Charleston, SC.

Abstract

OBJECTIVE:

The aim of this work was to investigate whether an imaging measure of corticospinal tract (CST) injury in the acute phase can predict motor outcome at 3 months in comparison to clinical assessment of initial motor impairment.

METHODS:

A two-site prospective cohort study followed up a group of first-ever ischemic stroke patients using the Upper-Extremity Fugl-Meyer (UE-FM) Scale to measure motor impairment in the acute phase and at 3 months. A weighted CST lesion load (wCST-LL) was calculated by overlaying the patient's lesion map on magnetic resonance imaging with a probabilistic CST constructed from healthy control subjects. Regression models were fit to assess the predictive value of wCST-LL and compared with initial motor impairment.

RESULTS:

Seventy-six patients (37 from cohort 1 and 39 from cohort 2) completed the study. wCST-LL as well as assessment of motor impairment (UE-FM) in the acute phase correlated with motor impairment (UE-FM) at 3 months in both cohort 1 (R(2)  = 0.69 vs. R(2)  = 0.67; p = 0.43) and cohort 2 (R(2)  = 0.69 vs. R(2)  = 0.62; p = 0.25). In the severely impaired subgroup (defined as UE-FM ≤ 10 at baseline), wCST-LL correlated with outcomes significantly better than clinical assessment (R(2)  = 0.47 vs. R(2)  = 0.11; p = 0.03). In the nonseverely impaired subgroup, stroke patients recovered approximately 70% of their maximal recovery potential. All stroke patients in both cohorts had poor motor outcomes at 3 months (defined as UE-FM ≤ 25) when wCST-LL was ≥ 7.0 cc (positive predictive value was 100%).

INTERPRETATION:

wCST-LL, an imaging biomarker determined in the acute phase, can predict poststroke motor outcomes at 3 months, especially in patients with severe impairment at baseline.

PMID:
26289123
PMCID:
PMC4715758
DOI:
10.1002/ana.24510
[Indexed for MEDLINE]
Free PMC Article

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