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Boren SB, Savitz SI, Gonzales N, Hasan K, Becerril-Gaitan A, Maroufy V, Li Y, Grotta J, Steven EA, Chen CJ, Sitton CW, Aronowski J, Haque ME. Longitudinal Morphometric Changes in the Corticospinal Tract Shape After Hemorrhagic Stroke. Transl Stroke Res 2024; 15:893-901. [PMID: 37308620 DOI: 10.1007/s12975-023-01168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
Deep intracerebral hemorrhage (ICH) exerts a direct force on corticospinal tracts (CST) causing shape deformation. Using serial MRI, Generalized Procrustes Analysis (GPA), and Principal Components Analysis (PCA), we temporally evaluated the change in CST shape. Thirty-five deep ICH patients with ipsilesional-CST deformation were serially imaged on a 3T-MRI with a median imaging time of day-2 and 84 of onset. Anatomical and diffusion tensor images (DTI) were acquired. Using DTI color-coded maps, 15 landmarks were drawn on each CST and the centroids were computed in 3 dimensions. The contralesional-CST landmarks were used as a reference. The GPA outlined the shape coordinates and we superimposed the ipsilesional-CST shape at the two-time points. A multivariate PCA was applied to identify eigenvectors associated with the highest percentile of change. The first three principal components representing CST deformation along the left-right (PC1), anterior-posterior (PC2), and superior-inferior (PC3) respectively were responsible for 57.9% of shape variance. The PC1 (36.1%, p < 0.0001) and PC3 (9.58%, p < 0.01) showed a significant deformation between the two-time points. Compared to the contralesional-CST, the ipsilesional PC scores were significantly (p < 0.0001) different only at the first-timepoint. A significant positive association between the ipsilesional-CST deformation and hematoma volume was observed. We present a novel method to quantify CST deformation caused by ICH. Deformation most often occurs in left-right axis (PC1) and superior-inferior (PC3) directions. As compared to the reference, the significant temporal difference at the first time point suggests CST restoration over time.
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Affiliation(s)
- Seth B Boren
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Nicole Gonzales
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX, 77030, USA
- Department of Neurology, Neurohospitalist and Stroke Section, University of Colorado School of Medicine, Aurora, USA
| | - Khader Hasan
- Department of Interventional Diagnostic Radiology, McGovern Medical School, The University of Texas Health Science Center, Houston, USA
| | - Andrea Becerril-Gaitan
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center, Houston, USA
| | - Vahed Maroufy
- Department of Biostatistics and Data Science, School of Public Health, McGovern Medical School, The University of Texas Health Science Center, Houston, USA
| | - Yuan Li
- Department of Biostatistics and Data Science, School of Public Health, McGovern Medical School, The University of Texas Health Science Center, Houston, USA
| | - James Grotta
- Stroke Research and Mobile Stroke Unit, Department of Neurology, Memorial Hermann Hospital, Houston, USA
| | - Emily A Steven
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center, Houston, USA
| | - Clark W Sitton
- Department of Interventional Diagnostic Radiology, McGovern Medical School, The University of Texas Health Science Center, Houston, USA
| | - Jaroslaw Aronowski
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Muhammad E Haque
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX, 77030, USA.
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Awaji A, Fuchigami T, Ogata R, Morioka S. Effects of Vibration-Based Generation of Timing of Tactile Perception on Upper Limb Function After Stroke: A Case Study. Cureus 2023; 15:e50855. [PMID: 38249200 PMCID: PMC10798842 DOI: 10.7759/cureus.50855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Sensorimotor dysfunction of the fingers and hands hinders the recovery of motor function post-stroke. Generally, hemiplegic patients are unable to properly control the dynamic friction generated between their fingers and objects during hand/finger muscle activity. In addition to sensory information, a sense of agency generated by the temporal synchronization of sensory prediction and sensory feedback is required to control this dynamic friction. In the present study, we utilized a novel rehabilitation device that transmits real-time fingertip contact information to a transducer in a case of stroke hemiplegia with sensorimotor deficits and stagnated hand/finger motor performance. Post-intervention, the patient's upper extremity motor function score (FMA-UE), which had previously been in a state of arrested recovery, improved from 51/66 to 61/66, especially in the wrist joints. Excessive grip force during object grasping and frequency of falling objects was notably decreased post-intervention. We believe that rehabilitation tasks using perceptual generation via transducer will be a new tool for the rehabilitation of post-stroke hand/finger sensorimotor deficits.
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Affiliation(s)
- Ayaka Awaji
- Department of Physical Therapy, Faculty of Health Sciences, Kio University, Nara, JPN
| | - Takeshi Fuchigami
- Neurorehabilitation Research Center, Kio University, Nara, JPN
- Department of Rehabilitation, Kishiwada Rehabilitation Hospital, Osaka, JPN
- Stroke Rehabilitation Research Laboratory, Kishiwada Rehabilitation Hospital, Osaka, JPN
| | - Rento Ogata
- Department of Rehabilitation, Kishiwada Rehabilitation Hospital, Osaka, JPN
- Stroke Rehabilitation Research Laboratory, Kishiwada Rehabilitation Hospital, Osaka, JPN
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, JPN
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, JPN
- Stroke Rehabilitation Research Laboratory, Kishiwada Rehabilitation Hospital, Osaka, JPN
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Shiba T, Mizuta N, Hasui N, Kominami Y, Nakatani T, Taguchi J, Morioka S. Effect of bihemispheric transcranial direct current stimulation on distal upper limb function and corticospinal tract excitability in a patient with subacute stroke: a case study. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1250579. [PMID: 37732289 PMCID: PMC10507690 DOI: 10.3389/fresc.2023.1250579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
Introduction Activation of the unaffected hemisphere contributes to motor function recovery post stroke in patients with severe upper limb motor paralysis. Transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation to increase the excitability of motor-related areas. tDCS has been reported to improve upper limb motor function; nonetheless, its effects on corticospinal tract excitability and muscle activity patterns during upper limb exercise remain unclear. Additionally, it is unclear whether simultaneously applied bihemispheric tDCS is more effective than anodal tDCS, which stimulates only one hemisphere. This study examined the effects of bihemispheric tDCS training on corticospinal tract excitability and muscle activity patterns during upper limb movements in a patient with subacute stroke. Methods In this single-case retrospective study, the Fugl-Meyer Assessment, Box and Block Test, electromyography, and intermuscular coherence measurement were performed. Intermuscular coherence was calculated at 15-30 Hz, which reflects corticospinal tract excitability. Results The results indicated that bihemispheric tDCS improved the Fugl-Meyer Assessment, Box and Block Test, co-contraction, and intermuscular coherence results, as compared with anodal tDCS. Discussion: These results reveal that upper limb training with bihemispheric tDCS improves corticospinal tract excitability and muscle activity patterns in patients with subacute stroke.
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Affiliation(s)
- Takahiro Shiba
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
| | - Naomichi Mizuta
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, Aichi, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Naruhito Hasui
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Yohei Kominami
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
| | - Junji Taguchi
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
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Jacquemont T, Valabregue R, Daghsen L, Moulton E, Zavanone C, Lamy JC, Rosso C. Association between superior longitudinal fasciculus, motor recovery, and motor outcome after stroke: a cohort study. Front Neurol 2023; 14:1157625. [PMID: 37521287 PMCID: PMC10375792 DOI: 10.3389/fneur.2023.1157625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Parieto-frontal interactions are mediated by the superior longitudinal fasciculus (SLF) and are crucial to integrate visuomotor information and mediate fine motor control. In this study, we aimed to characterize the relation of white matter integrity of both parts of the SLF (SLF I and SLF II) to both motor outcome and recovery and its evolution over time in stroke patients with upper limb motor deficits. Materials and methods Fractional anisotropy (FA) values over the SLF I, SLF II, and corticospinal tract (CST) and upper limb motor performance evaluated by both the upper limb Fugl-Meyer Assessment score and maximum grip strength were measured for 16 patients at 3 weeks, 6 weeks, and 12 weeks poststroke. FA changes were assessed over time using repeated-measures Friedman ANOVA, and correlations between motor recovery, motor outcome at 12 weeks, and FA values in the CST, SLF I, and SLF II at 3 weeks were performed using Spearman's rank-order correlation. Results FA values in the affected hemisphere's SLF I and SLF II at 3 weeks correlated with motor recovery at 12 weeks when assessed by the Fugl-Meyer Assessment for upper limb extremity (rho: 0.502, p: 0.04 and rho: 0.510, p: 0.04, respectively) but not when assessed by grip strength. FA values in the SLF I and SLF II were not correlated with motor outcomes. FA values in the SLF II in the affected hemisphere changed significantly over time (p: 0.016). Conclusion Both SLF I and SLF II appeared to participate in poststroke motor recovery of complex movements but not in the motor outcome. These results argue that visually/spatially oriented motor tasks as well as more complex motor tasks using parietal associative areas should be used for poststroke rehabilitation strategies.
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Affiliation(s)
- Thomas Jacquemont
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | | | - Lina Daghsen
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Eric Moulton
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Chiara Zavanone
- STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Service de Soins de Suite et Réeducation, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean Charles Lamy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Centre de Neuro-Imagerie de Recherche, CENIR, ICM, Paris, France
| | - Charlotte Rosso
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- STARE Team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
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Goeldlin M, Stewart C, Radojewski P, Wiest R, Seiffge D, Werring DJ. Clinical neuroimaging in intracerebral haemorrhage related to cerebral small vessel disease: contemporary practice and emerging concepts. Expert Rev Neurother 2022; 22:579-594. [PMID: 35850578 DOI: 10.1080/14737175.2022.2104157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION About 80% of all non-traumatic intracerebral haemorrhage (ICH) are caused by the sporadic cerebral small vessel diseases deep perforator arteriopathy (DPA, also termed hypertensive arteriopathy or arteriolosclerosis) and cerebral amyloid angiopathy (CAA), though these frequently co-exist in older people. Contemporary neuroimaging (MRI and CT) detects an increasing spectrum of haemorrhagic and non-haemorrhagic imaging biomarkers of small vessel disease which may identify the underlying arteriopathies. AREAS COVERED We discuss biomarkers for cerebral small vessel disease subtypes in ICH, and explore their implications for clinical practice and research. EXPERT OPINION ICH is not a single disease, but results from a defined range of vascular pathologies with important implications for prognosis and treatment. The terms "primary" and "hypertensive" ICH are poorly defined and should be avoided, as they encourage incomplete investigation and classification. Imaging-based criteria for CAA will show improved diagnostic accuracy, but specific imaging biomarkers of DPA are needed. Ultra-high-field 7T-MRI using structural and quantitative MRI may provide further insights into mechanisms and pathophysiology of small vessel disease. We expect neuroimaging biomarkers and classifications to allow personalized treatments (e.g. antithrombotic drugs) in clinical practice and to improve patient selection and monitoring in trials of targeted therapies directed at the underlying arteriopathies.
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Affiliation(s)
- Martina Goeldlin
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Catriona Stewart
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Piotr Radojewski
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - David J Werring
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, United Kingdom
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6
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Srivastava A, Kumar P, Prasad M, Das A, Vibha D, Garg A, Goyal V. Utility of transcranial magnetic stimulation and diffusion tensor imaging for prediction of upper-limb motor recovery in acute ischemic stroke patients. Ann Indian Acad Neurol 2022; 25:54-59. [PMID: 35342270 PMCID: PMC8954333 DOI: 10.4103/aian.aian_254_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/15/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The recovery of the upper-limb (UL) motor function after ischemic stroke (IS) remains a major scientific, clinical, and patient concern and it is hard to predict alone from the clinical symptoms. Objective: To determine the accuracy of the prediction of the recovery of UL motor function in patients with acute ischemic middle cerebral artery (MCA) stroke using individual clinical, transcranial magnetic stimulation (TMS) or diffusion tensor imaging (DTI) parameters or their combination. Methods and Material: The first-ever acute ischemic MCA stroke patients within 7 days of the stroke onset who had an obvious UL motor deficit underwent TMS for the presence of motor-evoked potential (MEP) and DTI to evaluate the integrity of corticospinal tracts. Multivariate logistic regression analysis was done to test for the accuracy of the prediction of the recovery of UL motor function. Results: Twenty-nine acute ischemic MCA stroke patients (21 males and 8 females) with a mean age of 51.45 ± 14.26 years were recruited. Model-I included clinical scales (Fugl-Meyer Assessment [FMA] + Motricity Index [MI]) + TMS (MEP) + DTI (fractional anisotropy [FA]) were found to be the most accurate predictive model, with the overall predictive ability (93.3%; 95% confidence interval [CI]: 0.87–0.99) and sensitivity: 94.9% (95% CI: 0.87–1.0) and specificity: 95.8% (95% CI: 0.89–1.0); respectively. Conclusion: The accuracy of UL motor recovery can be predicted through the clinical battery and their elements as well as TMS (MEP) and DTI (FA) parameters. Further, well-designed prospective studies are needed to confirm our findings.
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7
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Kimura I, Oishi H, Hayashi MJ, Amano K. Microstructural Properties of Human Brain Revealed by Fractional Anisotropy Can Predict the After-Effect of Intermittent Theta Burst Stimulation. Cereb Cortex Commun 2021; 3:tgab065. [PMID: 35083435 PMCID: PMC8784864 DOI: 10.1093/texcom/tgab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract
Intermittent theta burst stimulation (iTBS) delivered by transcranial magnetic stimulation (TMS) produces a long-term potentiation-like after-effect useful for investigations of cortical function and of potential therapeutic value. However, the iTBS after-effect over the primary motor cortex (M1) as measured by changes in motor evoked potential (MEP) amplitude exhibits a largely unexplained variability across individuals. Here, we present evidence that individual differences in white matter (WM) and gray matter (GM) microstructural properties revealed by fractional anisotropy (FA) predict the magnitude of the iTBS-induced after-effect over M1. The MEP amplitude change in the early phase (5–10 min post-iTBS) was associated with FA values in WM tracts such as right superior longitudinal fasciculus and corpus callosum. By contrast, the MEP amplitude change in the late phase (15–30 min post-iTBS) was associated with FA in GM, primarily in right frontal cortex. These results suggest that the microstructural properties of regions connected directly or indirectly to the target region (M1) are crucial determinants of the iTBS after-effect. FA values indicative of these microstructural differences can predict the potential effectiveness of repetitive TMS for both investigational use and clinical application.
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Affiliation(s)
- Ikko Kimura
- Address correspondence to Ikko Kimura, 1-4 Yamadaoka, Suita 565-0871, Japan. ; Kaoru Amano, 7-3-1 Hongo, Bunkyo-ku 113-8656, Japan.
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8
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Leon-Rojas J, Cornell I, Rojas-Garcia A, D’Arco F, Panovska-Griffiths J, Cross H, Bisdas S. The role of preoperative diffusion tensor imaging in predicting and improving functional outcome in pediatric patients undergoing epilepsy surgery: a systematic review. BJR Open 2021; 3:20200002. [PMID: 34381942 PMCID: PMC8320117 DOI: 10.1259/bjro.20200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) is a useful neuroimaging technique for surgical planning in adult patients. However, no systematic review has been conducted to determine its utility for pre-operative analysis and planning of Pediatric Epilepsy surgery. We sought to determine the benefit of pre-operative DTI in predicting and improving neurological functional outcome after epilepsy surgery in children with intractable epilepsy. METHODS A systematic review of articles in English using PubMed, EMBASE and Scopus databases, from inception to January 10, 2020 was conducted. All studies that used DTI as either predictor or direct influencer of functional neurological outcome (motor, sensory, language and/or visual) in pediatric epilepsy surgical candidates were included. Data extraction was performed by two blinded reviewers. Risk of bias of each study was determined using the QUADAS 2 Scoring System. RESULTS 13 studies were included (6 case reports/series, 5 retrospective cohorts, and 2 prospective cohorts) with a total of 229 patients. Seven studies reported motor outcome; three reported motor outcome prediction with a sensitivity and specificity ranging from 80 to 85.7 and 69.6 to 100%, respectively; four studies reported visual outcome. In general, the use of DTI was associated with a high degree of favorable neurological outcomes after epilepsy surgery. CONCLUSION Multiple studies show that DTI helps to create a tailored plan that results in improved functional outcome. However, more studies are required in order to fully assess its utility in pediatric patients. This is a desirable field of study because DTI offers a non-invasive technique more suitable for children. ADVANCES IN KNOWLEDGE This systematic review analyses, exclusively, studies of pediatric patients with drug-resistant epilepsy and provides an update of the evidence regarding the role of DTI, as part of the pre-operative armamentarium, in improving post-surgical neurological sequels and its potential for outcome prediction.
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Affiliation(s)
| | - Isabel Cornell
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
| | | | - Felice D’Arco
- Department of Pediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Helen Cross
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
- NeurALL Research Group, Universidad Internacional del Ecuador, Medical School, Quito, Ecuador
- Department of Applied Health Research, University College London, London, UK
- Department of Pediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
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9
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Current applications of diffusion tensor tractography analysis of corticospinal tracts for prognostication of motor outcomes or optimization of neurosurgical intervention in hypertensive intracranial hemorrhage. BRAIN HEMORRHAGES 2021. [DOI: 10.1016/j.hest.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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10
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Jordan KM, Keshavan A, Caverzasi E, Osorio J, Papinutto N, Amirbekian B, Berger MS, Henry RG. Longitudinal Disconnection Tractograms to Investigate the Functional Consequences of White Matter Damage: An Automated Pipeline. J Neuroimaging 2020; 30:443-457. [PMID: 32436352 DOI: 10.1111/jon.12713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/27/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Neurosurgical resection is one of the few opportunities researchers have to image the human brain pre- and postfocal damage. A major challenge associated with brains undergoing surgical resection is that they often do not fit brain templates most image-processing methodologies are based on. Manual intervention is required to reconcile the pathology, requiring time investment and introducing reproducibility concerns, and extreme cases must be excluded. METHODS We propose an automatic longitudinal pipeline based on High Angular Resolution Diffusion Imaging acquisitions to facilitate a Pathway Lesion Symptom Mapping analysis relating focal white matter injury to functional deficits. This two-part approach includes (i) automatic segmentation of focal white matter injury from anisotropic power differences, and (ii) modeling disconnection using tractography on the single-subject level, which specifically identifies the disconnections associated with focal white matter damage. RESULTS The advantages of this approach stem from (1) objective and automatic lesion segmentation and tractogram generation, (2) objective and precise segmentation of affected tissue likely to be associated with damage to long-range white matter pathways (defined by anisotropic power), (3) good performance even in the cases of anatomical distortions by use of nonlinear tensor-based registration, which aligns images using an approach sensitive to white matter microstructure. CONCLUSIONS Mapping a system as variable and complex as the human brain requires sample sizes much larger than the current technology can support. This pipeline can be used to execute large-scale, sufficiently powered analyses by meeting the need for an automatic approach to objectively quantify white matter disconnection.
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Affiliation(s)
- Kesshi M Jordan
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Anisha Keshavan
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Eduardo Caverzasi
- Department of Neurology, University of California, San Francisco, CA
| | - Joseph Osorio
- Division of Neurosurgery, Department of Surgery, University of California, San Diego, CA
| | - Nico Papinutto
- Department of Neurology, University of California, San Francisco, CA
| | - Bagrat Amirbekian
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Mitchel S Berger
- Department of Neurosurgery, University of California, San Francisco, CA
| | - Roland G Henry
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
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11
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Loera-Valencia R, Cedazo-Minguez A, Kenigsberg PA, Page G, Duarte AI, Giusti P, Zusso M, Robert P, Frisoni GB, Cattaneo A, Zille M, Boltze J, Cartier N, Buee L, Johansson G, Winblad B. Current and emerging avenues for Alzheimer's disease drug targets. J Intern Med 2019; 286:398-437. [PMID: 31286586 DOI: 10.1111/joim.12959] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alzheimer's disease (AD), the most frequent cause of dementia, is escalating as a global epidemic, and so far, there is neither cure nor treatment to alter its progression. The most important feature of the disease is neuronal death and loss of cognitive functions, caused probably from several pathological processes in the brain. The main neuropathological features of AD are widely described as amyloid beta (Aβ) plaques and neurofibrillary tangles of the aggregated protein tau, which contribute to the disease. Nevertheless, AD brains suffer from a variety of alterations in function, such as energy metabolism, inflammation and synaptic activity. The latest decades have seen an explosion of genes and molecules that can be employed as targets aiming to improve brain physiology, which can result in preventive strategies for AD. Moreover, therapeutics using these targets can help AD brains to sustain function during the development of AD pathology. Here, we review broadly recent information for potential targets that can modify AD through diverse pharmacological and nonpharmacological approaches including gene therapy. We propose that AD could be tackled not only using combination therapies including Aβ and tau, but also considering insulin and cholesterol metabolism, vascular function, synaptic plasticity, epigenetics, neurovascular junction and blood-brain barrier targets that have been studied recently. We also make a case for the role of gut microbiota in AD. Our hope is to promote the continuing research of diverse targets affecting AD and promote diverse targeting as a near-future strategy.
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Affiliation(s)
- R Loera-Valencia
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - A Cedazo-Minguez
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - G Page
- Neurovascular Unit and Cognitive impairments - EA3808, University of Poitiers, Poitiers, France
| | - A I Duarte
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - P Giusti
- Dipartimento di Scienze del Farmaco, Università degli Studi di Padova, Padova, Italy
| | - M Zusso
- Dipartimento di Scienze del Farmaco, Università degli Studi di Padova, Padova, Italy
| | - P Robert
- CoBTeK - lab, CHU Nice University Côte d'Azur, Nice, France
| | - G B Frisoni
- University Hospitals and University of Geneva, Geneva, Switzerland
| | - A Cattaneo
- University Hospitals and University of Geneva, Geneva, Switzerland
| | - M Zille
- Institute of Experimental and Clinical Pharmacology and Toxicology, Lübeck, Germany
| | - J Boltze
- School of Life Sciences, The University of Warwick, Coventry, UK
| | - N Cartier
- Preclinical research platform, INSERM U1169/MIRCen Commissariat à l'énergie atomique, Fontenay aux Roses, France.,Université Paris-Sud, Orsay, France
| | - L Buee
- Alzheimer & Tauopathies, LabEx DISTALZ, CHU-Lille, Inserm, Univ. Lille, Lille, France
| | - G Johansson
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - B Winblad
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
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12
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Sagnier S, Sibon I. The new insights into human brain imaging after stroke. J Neurosci Res 2019; 100:1171-1181. [PMID: 31498491 DOI: 10.1002/jnr.24525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 12/16/2022]
Abstract
Over the last two decades, developments of human brain stroke imaging have raised several questions about the place of new MRI biomarkers in the acute management of stroke and the prediction of poststroke outcome. Recent studies have demonstrated the main role of perfusion-weighted imaging in the identification of the best cerebral perfusion profile for a better response after reperfusion therapies in acute ischemic stroke. A major issue remains the early prediction of stroke outcome. While voxel-based lesion-symptom mapping emphasized the influence of stroke location, the analysis of the brain parenchyma underpinning the stroke lesion showed the relevance of prestroke cerebral status, including cortical atrophy, white matter integrity, or presence of chronic cortical cerebral microinfarcts. Moreover, besides the evaluation of the visually abnormal brain tissue, the analysis of normal-appearing brain parenchyma using diffusion tensor imaging and magnetization transfer imaging or spectroscopy offered new biomarkers to improve the prediction of the prognosis and new targets to follow in therapeutic trials. The aim of this review was to depict the main new radiological biomarkers reported in the last two decades that will provide a more thorough prediction of functional, motor, and neuropsychological outcome following the stroke. These new developments in neuroimaging might be a cornerstone in the emerging personalized medicine for stroke patients.
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Affiliation(s)
- Sharmila Sagnier
- UMR-5287 CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France.,CHU de Bordeaux, Unité Neuro-vasculaire, Bordeaux, France
| | - Igor Sibon
- UMR-5287 CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France.,CHU de Bordeaux, Unité Neuro-vasculaire, Bordeaux, France
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13
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Oey NE, Samuel GS, Lim JKW, VanDongen AM, Ng YS, Zhou J. Whole Brain White Matter Microstructure and Upper Limb Function: Longitudinal Changes in Fractional Anisotropy and Axial Diffusivity in Post-Stroke Patients. J Cent Nerv Syst Dis 2019; 11:1179573519863428. [PMID: 31391787 PMCID: PMC6668170 DOI: 10.1177/1179573519863428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 06/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) measuring fractional anisotropy (FA) and axial diffusivity (AD) may be a useful biomarker for monitoring changes in white matter after stroke, but its associations with upper-limb motor recovery have not been well studied. We aim to describe changes in the whole-brain FA and AD in five post-stroke patients in relation to kinematic measures of elbow flexion to better understand the relationship between FA and AD changes and clinico-kinematic measures of upper limb motor recovery. Methods We performed DTI MRI at two timepoints during the acute phase of stroke, measuring FA and AD across 48 different white matter tract regions in the brains of five hemiparetic patients with infarcts in the cortex, pons, basal ganglia, thalamus, and corona radiata. We tracked the progress of these patients using clinical Fugl-Meyer Assessments and kinematic measures of elbow flexion at the acute phase within 14 (mean: 9.4 ± 2.49) days of stroke symptom onset and at a follow-up appointment 2 weeks later (mean: 16 ± 1.54) days. Results Changes in FA and AD in 48 brain regions occurring during stroke rehabilitation are described in relation to motor recovery. In this case series, one patient with a hemipontine infarct showed an increase in FA of the ipsilateral and contralateral corticospinal tract, whereas other patients with lesions involving the corona radiata and middle cerebral artery showed widespread decreases in perilesional FA. On the whole, FA and AD seemed to behave inversely to each other. Conclusions This case series describes longitudinal changes in perilesional and remote FA and AD in relation to kinematic parameters of elbow flexion at the subacute post-stroke period. Although studies with larger sample sizes are needed, our findings indicate that longitudinally measured changes in DTI-based measurements of white matter microstructural integrity may aid in the prognostication of patients affected by motor stroke.
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Affiliation(s)
- Nicodemus Edrick Oey
- Singapore Health Services, Singapore.,Programme in Neuroscience and Behavioural Disorders, Center for Cognitive Neuroscience, Duke-NUS Medical School, Singapore
| | | | - Joseph Kai Wei Lim
- Programme in Neuroscience and Behavioural Disorders, Center for Cognitive Neuroscience, Duke-NUS Medical School, Singapore
| | - Antonius Mj VanDongen
- Programme in Neuroscience and Behavioural Disorders, Center for Cognitive Neuroscience, Duke-NUS Medical School, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
| | - Juan Zhou
- Programme in Neuroscience and Behavioural Disorders, Center for Cognitive Neuroscience, Duke-NUS Medical School, Singapore.,Clinical Imaging Research Center, Agency for Science, Technology and Research (ASTAR), Singapore
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14
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Moura LM, Luccas R, de Paiva JPQ, Amaro E, Leemans A, Leite CDC, Otaduy MCG, Conforto AB. Diffusion Tensor Imaging Biomarkers to Predict Motor Outcomes in Stroke: A Narrative Review. Front Neurol 2019; 10:445. [PMID: 31156529 PMCID: PMC6530391 DOI: 10.3389/fneur.2019.00445] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/12/2019] [Indexed: 12/14/2022] Open
Abstract
Stroke is a leading cause of disability worldwide. Motor impairments occur in most of the patients with stroke in the acute phase and contribute substantially to disability. Diffusion tensor imaging (DTI) biomarkers such as fractional anisotropy (FA) measured at an early phase after stroke have emerged as potential predictors of motor recovery. In this narrative review, we: (1) review key concepts of diffusion MRI (dMRI); (2) present an overview of state-of-art methodological aspects of data collection, analysis and reporting; and (3) critically review challenges of DTI in stroke as well as results of studies that investigated the correlation between DTI metrics within the corticospinal tract and motor outcomes at different stages after stroke. We reviewed studies published between January, 2008 and December, 2018, that reported correlations between DTI metrics collected within the first 24 h (hyperacute), 2-7 days (acute), and >7-90 days (early subacute) after stroke. Nineteen studies were included. Our review shows that there is no consensus about gold standards for DTI data collection or processing. We found great methodological differences across studies that evaluated DTI metrics within the corticospinal tract. Despite heterogeneity in stroke lesions and analysis approaches, the majority of studies reported significant correlations between DTI biomarkers and motor impairments. It remains to be determined whether DTI results could enhance the predictive value of motor disability models based on clinical and neurophysiological variables.
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Affiliation(s)
- Luciana M. Moura
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Rafael Luccas
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | | | - Edson Amaro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Alexander Leemans
- PROVIDI Lab, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands
| | - Claudia da C. Leite
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Maria C. G. Otaduy
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Adriana B. Conforto
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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15
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Puig J, Blasco G, Terceño M, Daunis-I-Estadella P, Schlaug G, Hernandez-Perez M, Cuba V, Carbó G, Serena J, Essig M, Figley CR, Nael K, Leiva-Salinas C, Pedraza S, Silva Y. Predicting Motor Outcome in Acute Intracerebral Hemorrhage. AJNR Am J Neuroradiol 2019; 40:769-775. [PMID: 31000524 DOI: 10.3174/ajnr.a6038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/15/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Predicting motor outcome following intracerebral hemorrhage is challenging. We tested whether the combination of clinical scores and DTI-based assessment of corticospinal tract damage within the first 12 hours of symptom onset after intracerebral hemorrhage predicts motor outcome at 3 months. MATERIALS AND METHODS We prospectively studied patients with motor deficits secondary to primary intracerebral hemorrhage within the first 12 hours of symptom onset. Patients underwent multimodal MR imaging including DTI. We assessed intracerebral hemorrhage and perihematomal edema location and volume, and corticospinal tract involvement. The corticospinal tract was considered affected when the tractogram passed through the intracerebral hemorrhage or/and the perihematomal edema. We also calculated affected corticospinal tract-to-unaffected corticospinal tract ratios for fractional anisotropy, mean diffusivity, and axial and radial diffusivities. Motor impairment was graded by the motor subindex scores of the modified NIHSS. Motor outcome at 3 months was classified as good (modified NIHSS 0-3) or poor (modified NIHSS 4-8). RESULTS Of 62 patients, 43 were included. At admission, the median NIHSS score was 13 (interquartile range = 8-17), and the median modified NIHSS score was 5 (interquartile range = 2-8). At 3 months, 13 (30.23%) had poor motor outcome. Significant independent predictors of motor outcome were NIHSS and modified NIHSS at admission, posterior limb of the internal capsule involvement by intracerebral hemorrhage at admission, intracerebral hemorrhage volume at admission, 72-hour NIHSS, and 72-hour modified NIHSS. The sensitivity, specificity, and positive and negative predictive values for poor motor outcome at 3 months by a combined modified NIHSS of >6 and posterior limb of the internal capsule involvement in the first 12 hours from symptom onset were 84%, 79%, 65%, and 92%, respectively (area under the curve = 0.89; 95% CI, 0.78-1). CONCLUSIONS Combined assessment of motor function and posterior limb of the internal capsule damage during acute intracerebral hemorrhage accurately predicts motor outcome.
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Affiliation(s)
- J Puig
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - G Blasco
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - M Terceño
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science (P.D.-i.-E.), Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - G Schlaug
- Neuroimaging and Stroke Recovery Laboratory (G.S.), Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - M Hernandez-Perez
- Department of Neurosciences (M.H.-P.), Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - V Cuba
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - G Carbó
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - J Serena
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - M Essig
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
| | - C R Figley
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
| | - K Nael
- Department of Radiology (K.N.), Icahn School of Medicine at Mount Sinai, New York
| | - C Leiva-Salinas
- Department of Radiology (C.L.-S.), University of Missouri, Columbia, Missouri
| | - S Pedraza
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - Y Silva
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
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16
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Tae WS, Ham BJ, Pyun SB, Kang SH, Kim BJ. Current Clinical Applications of Diffusion-Tensor Imaging in Neurological Disorders. J Clin Neurol 2018; 14:129-140. [PMID: 29504292 PMCID: PMC5897194 DOI: 10.3988/jcn.2018.14.2.129] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 12/11/2022] Open
Abstract
Diffusion-tensor imaging (DTI) is a noninvasive medical imaging tool used to investigate the structure of white matter. The signal contrast in DTI is generated by differences in the Brownian motion of the water molecules in brain tissue. Postprocessed DTI scalars can be used to evaluate changes in the brain tissue caused by disease, disease progression, and treatment responses, which has led to an enormous amount of interest in DTI in clinical research. This review article provides insights into DTI scalars and the biological background of DTI as a relatively new neuroimaging modality. Further, it summarizes the clinical role of DTI in various disease processes such as amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, Alzheimer's dementia, epilepsy, ischemic stroke, stroke with motor or language impairment, traumatic brain injury, spinal cord injury, and depression. Valuable DTI postprocessing tools for clinical research are also introduced.
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Affiliation(s)
- Woo Suk Tae
- Brain Convergence Research Center, Korea University, Seoul, Korea
| | - Byung Joo Ham
- Brain Convergence Research Center, Korea University, Seoul, Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Sung Bom Pyun
- Brain Convergence Research Center, Korea University, Seoul, Korea
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Shin Hyuk Kang
- Brain Convergence Research Center, Korea University, Seoul, Korea
- Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea
| | - Byung Jo Kim
- Brain Convergence Research Center, Korea University, Seoul, Korea
- Department of Neurology, Korea University College of Medicine, Seoul, Korea.
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17
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Koyama T, Koumo M, Uchiyama Y, Domen K. Utility of Fractional Anisotropy in Cerebral Peduncle for Stroke Outcome Prediction: Comparison of Hemorrhagic and Ischemic Strokes. J Stroke Cerebrovasc Dis 2017; 27:878-885. [PMID: 29174878 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/11/2017] [Accepted: 10/21/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diffusion-tensor fractional anisotropy (FA) has been used for predicting stroke outcome. However, most previous studies focused on patients with either hemorrhagic or ischemic stroke. The aim of this study was to assess the correlation between FA and outcome for patients with hemorrhagic stroke and those with ischemic stroke, and then compare their correlation patterns. METHODS This study sampled 40 hemorrhagic and 40 ischemic stroke patients from our previously published reports. Diffusion-tensor images were obtained on days 14-21, and FA images were generated, after which the ratio of FA within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated. Outcome was assessed using Brunnstrom stage (BRS), motor component of the functional independence measure (FIM-motor), and total length of hospital stay (LOS) at discharge from our affiliated rehabilitation hospital. The data were then compared between the hemorrhage and the infarct groups. Correlation analyses between rFA and outcome assessments were performed separately for both groups and then were compared between the groups. RESULTS The hemorrhage group exhibited significantly more severe BRS, longer LOS, and lower rFA than the infarct group. The correlations between rFA and outcome measures were all statistically significant for both the hemorrhage and the infarct groups. The correlation patterns for BRS and LOS were very similar between the hemorrhage and the infarct groups. However, such similarity was not evident for FIM-motor. CONCLUSIONS FA in the cerebral peduncles may be used to predict extremity functions and LOS for both types of stroke.
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Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo 663-8211, Japan; Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
| | - Masatoshi Koumo
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo 663-8211, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
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18
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Abstract
RATIONALE A 33-year-old male presented with complete weakness of the right extremities due to corona radiata infarct. PATIENT CONCERNS The main concerns of the patient is recovery of hand function especially related to finger extension. DIAGNOSES Right corona radiata infarct. INTERVENTIONS He underwent physical therapy and occupational therapy at the outpatient clinic of the rehabilitation department of the same university hospital until 2 years after onset. In addition, he underwent neuromuscular electrical stimulation for the right finger extensors continuously until 4 years after onset. OUTCOMES At 6 months after onset, the weakness of his right side recovered to subnormal state except for the right finger extensors which were completely weak. At 1.5 years after onset, the right finger extensors began to show slow and continuous recovery. At 4 years after onset, the patient showed motor recovery in the right finger extensors to the extent that he was able to move against gravity. Discontinuation of the left corticospinal tract was observed on 2-month diffusion tensor tractography (DTT); however, the integrity of this discontinuation had recovered to the primary motor cortex on 4-year DTT. On 2-month transcranial magnetic stimulation (TMS), no motor-evoked potential was evoked; in contrast, motor-evoked potentials were obtained at the right-hand muscle on 4-year TMS study. LESSONS We demonstrated unusual delayed and long-term recovery of the affected finger extensors in a patient with corona radiata infarct using DTT and TMS.
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19
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Tao C, Hu X, Li H, You C. White Matter Injury after Intracerebral Hemorrhage: Pathophysiology and Therapeutic Strategies. Front Hum Neurosci 2017; 11:422. [PMID: 28890692 PMCID: PMC5575148 DOI: 10.3389/fnhum.2017.00422] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 08/04/2017] [Indexed: 02/05/2023] Open
Abstract
Intracerebral hemorrhage (ICH) accounts for 10%–30% of all types of stroke. Bleeding within the brain parenchyma causes gray matter (GM) destruction as well as proximal or distal white matter (WM) injury (WMI) due to complex pathophysiological mechanisms. Because WM has a distinct cellular architecture, blood supply pattern and corresponding function, and its response to stroke may vary from that of GM, a better understanding of the characteristics of WMI following ICH is essential and may shed new light on treatment options. Current evidence using histological, radiological and chemical biomarkers clearly confirms the spatio-temporal distribution of WMI post- ICH. Although certain types of pathological damage such as inflammatory, oxidative and neuro-excitotoxic injury to WM have been identified, the exact molecular mechanisms remain unclear. In this review article, we briefly describe the constitution and physiological function of brain WM, summarize evidence regarding WMI, and focus on the underlying pathophysiological mechanisms and therapeutic strategies.
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Affiliation(s)
- Chuanyuan Tao
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan UniversityChengdu, China
| | - Xin Hu
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan UniversityChengdu, China
| | - Hao Li
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan UniversityChengdu, China
| | - Chao You
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan UniversityChengdu, China
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20
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Rosenstock T, Giampiccolo D, Schneider H, Runge SJ, Bährend I, Vajkoczy P, Picht T. Specific DTI seeding and diffusivity-analysis improve the quality and prognostic value of TMS-based deterministic DTI of the pyramidal tract. NEUROIMAGE-CLINICAL 2017; 16:276-285. [PMID: 28840099 PMCID: PMC5560117 DOI: 10.1016/j.nicl.2017.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/22/2017] [Accepted: 08/11/2017] [Indexed: 12/17/2022]
Abstract
Object Navigated transcranial magnetic stimulation (nTMS) combined with diffusion tensor imaging (DTI) is used preoperatively in patients with eloquent-located brain lesions and allows analyzing non-invasively the spatial relationship between the tumor and functional areas (e.g. the motor cortex and the corticospinal tract [CST]). In this study, we examined the diffusion parameters FA (fractional anisotropy) and ADC (apparent diffusion coefficient) within the CST in different locations and analyzed their interrater reliability and usefulness for predicting the patients' motor outcome with a precise approach of specific region of interest (ROI) seeding based on the color-coded FA-map. Methods Prospectively collected data of 30 patients undergoing bihemispheric nTMS mapping followed by nTMS-based DTI fiber tracking prior to surgery of motor eloquent high-grade gliomas were analyzed by 2 experienced and 1 unexperienced examiner. The following data were scrutinized for both hemispheres after tractography based on nTMS-motor positive cortical seeds and a 2nd region of interest in one layer of the caudal pons defined by the color-coded FA-map: the pre- and postoperative motor status (day of discharge und 3 months), the closest distance between the tracts and the tumor (TTD), the fractional anisotropy (FA) and the apparent diffusion coefficient (ADC). The latter as an average within the CST as well as specific values in different locations (peritumoral, mesencephal, pontine). Results Lower average FA-values within the affected CST as well as higher average ADC-values are significantly associated with deteriorated postoperative motor function (p = 0.006 and p = 0.026 respectively). Segmental analysis within the CST revealed that the diffusion parameters are especially disturbed on a peritumoral level and that the degree of their impairment correlates with motor deficits (FA p = 0.065, ADC p = 0.007). No significant segmental variation was seen in the healthy hemisphere. The interrater reliability showed perfect agreement for almost all analyzed parameters. Conclusions Adding diffusion weighted imaging derived information on the structural integrity of the nTMS-based tractography results improves the predictive power for postoperative motor outcome. Utilizing a second subcortical ROI which is specifically seeded based on the color-coded FA map increases the tracking quality of the CST independently of the examiner's experience. Further prospective studies are needed to validate the nTMS-based prediction of the patient's outcome. ROI seeding based on nTMS-data and FA-maps improves DTI tractography of the CST. Perfect interrater reliability for DTI tractography of the CST was observed. The pattern of diffusivity disturbance predicts the postoperative motor outcome.
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Affiliation(s)
- Tizian Rosenstock
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Davide Giampiccolo
- Institute of Neurosurgery, University Hospital, Piazzale Stefani 1, 37100 Verona, Italy
| | - Heike Schneider
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophia Jutta Runge
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
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21
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Essayed WI, Zhang F, Unadkat P, Cosgrove GR, Golby AJ, O'Donnell LJ. White matter tractography for neurosurgical planning: A topography-based review of the current state of the art. Neuroimage Clin 2017; 15:659-672. [PMID: 28664037 PMCID: PMC5480983 DOI: 10.1016/j.nicl.2017.06.011] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022]
Abstract
We perform a review of the literature in the field of white matter tractography for neurosurgical planning, focusing on those works where tractography was correlated with clinical information such as patient outcome, clinical functional testing, or electro-cortical stimulation. We organize the review by anatomical location in the brain and by surgical procedure, including both supratentorial and infratentorial pathologies, and excluding spinal cord applications. Where possible, we discuss implications of tractography for clinical care, as well as clinically relevant technical considerations regarding the tractography methods. We find that tractography is a valuable tool in variable situations in modern neurosurgery. Our survey of recent reports demonstrates multiple potentially successful applications of white matter tractography in neurosurgery, with progress towards overcoming clinical challenges of standardization and interpretation.
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Affiliation(s)
- Walid I Essayed
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Fan Zhang
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Prashin Unadkat
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - G Rees Cosgrove
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren J O'Donnell
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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