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Brain Imaging Behav. 2018 May 15. doi: 10.1007/s11682-018-9851-y. [Epub ahead of print]

Early functional MRI activation predicts motor outcome after ischemic stroke: a longitudinal, multimodal study.

Du J1, Yang F1, Zhang Z2,3, Hu J1, Xu Q2, Hu J2, Zeng F2, Lu G4,5, Liu X6.

Author information

1
Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China.
2
Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China.
3
State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, 210002, China.
4
Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China. cjr.luguangming@vip.163.com.
5
State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, 210002, China. cjr.luguangming@vip.163.com.
6
Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China. xfliu2@vip.163.com.

Abstract

An accurate prediction of long term outcome after stroke is urgently required to provide early individualized neurorehabilitation. This study aimed to examine the added value of early neuroimaging measures and identify the best approaches for predicting motor outcome after stroke. This prospective study involved 34 first-ever ischemic stroke patients (time since stroke: 1-14 days) with upper limb impairment. All patients underwent baseline multimodal assessments that included clinical (age, motor impairment), neurophysiological (motor-evoked potentials, MEP) and neuroimaging (diffusion tensor imaging and motor task-based fMRI) measures, and also underwent reassessment 3 months after stroke. Bivariate analysis and multivariate linear regression models were used to predict the motor scores (Fugl-Meyer assessment, FMA) at 3 months post-stroke. With bivariate analysis, better motor outcome significantly correlated with (1) less initial motor impairment and disability, (2) less corticospinal tract injury, (3) the initial presence of MEPs, (4) stronger baseline motor fMRI activations. In multivariate analysis, incorporating neuroimaging data improved the predictive accuracy relative to only clinical and neurophysiological assessments. Baseline fMRI activation in SMA was an independent predictor of motor outcome after stroke. A multimodal model incorporating fMRI and clinical measures best predicted the motor outcome following stroke. fMRI measures obtained early after stroke provided independent prediction of long-term motor outcome.

KEYWORDS:

Diffusion tensor imaging; Functional magnetic resonance imaging; Motor deficits; Motor evoked potentials; Outcome prediction; Stroke

PMID:
29766355
DOI:
10.1007/s11682-018-9851-y

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