1
|
Koyama T, Mochizuki M, Uchiyama Y, Domen K. Outcome Prediction by Combining Corticospinal Tract Lesion Load with Diffusion-tensor Fractional Anisotropy in Patients after Hemorrhagic Stroke. Prog Rehabil Med 2024; 9:20240001. [PMID: 38223334 PMCID: PMC10782178 DOI: 10.2490/prm.20240001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024] Open
Abstract
Objectives The objective of this study was to evaluate the predictive precision of combining the corticospinal tract lesion load (CST-LL) with the diffusion-tensor fractional anisotropy of the corticospinal tract (CST-FA) in the lesioned hemispheres regarding motor outcomes. Methods Patients with putaminal and/or thalamic hemorrhage who had undergone computed tomography (CT) soon after onset in our hospital were retrospectively enrolled. The CST-LL was calculated after registration of the CT images to a standard brain. Diffusion-tensor imaging was performed during the second week after onset. Standardized automated tractography was employed to calculate the CST-FA. Outcomes were assessed at discharge from our affiliated rehabilitation facility using total scores of the motor component of the Stroke Impairment Assessment Set (SIAS-motor total; null to full, 0 to 25). Multivariate regression analysis was performed with CST-LL and CST-FA as explanatory variables and SIAS-motor total as a target value. Results Twenty-five patients participated in this study. SIAS-motor total ranged from 0 to 25 (median, 17). CST-LL ranged from 0.298 to 7.595 (median, 2.522) mL, and the lesion-side CST-FA ranged from 0.211 to 0.530 (median, 0.409). Analysis revealed that both explanatory variables were detected as statistically significant contributory factors. The estimated t values indicated that the contributions of these two variables were almost equal. The obtained regression model accounted for 63.9% of the variability of the target value. Conclusions Incorporation of the CST-LL with the lesion-side CST-FA enhances the precision of the stroke outcome prediction model.
Collapse
Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu
Neurosurgical Hospital, Nishinomiya, Japan
- Department of Rehabilitation Medicine, School of Medicine,
Hyogo Medical University, Nishinomiya, Japan
| | - Midori Mochizuki
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu
Neurosurgical Hospital, Nishinomiya, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine,
Hyogo Medical University, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, School of Medicine,
Hyogo Medical University, Nishinomiya, Japan
| |
Collapse
|
2
|
Koyama T, Mochizuki M, Uchiyama Y, Domen K. Applicability of fractional anisotropy from standardized automated tractography for outcome prediction of patients after stroke. J Phys Ther Sci 2023; 35:838-844. [PMID: 38075519 PMCID: PMC10698312 DOI: 10.1589/jpts.35.838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/14/2023] [Indexed: 03/22/2024] Open
Abstract
[Purpose] Diffusion-tensor fractional anisotropy has been used for outcome prediction in stroke patients. We assessed the clinical applicability of the two major fractional anisotropy methodologies-fractional anisotropy derived from segmentation maps in the standard brain (region of interest) and fractional anisotropy derived from standardized automated tractography-in relation to outcomes. [Participants and Methods] The study design was a retrospective survey of medical records collected from October 2021 to September 2022. Diffusion-tensor imaging was conducted in the second week after stroke onset. Outcomes were assessed using the total score of the motor component of the Stroke Impairment Assessment Set (null to full, 0 to 25). Correlations between fractional anisotropy and the outcomes were then assessed. [Results] Fourteen patients with hemorrhagic stroke were sampled. The fractional anisotropy from standardized automated tractography of the corticospinal tract on the lesion side (mean ± standard deviation, 0.403 ± 0.070) was significantly and tightly correlated (r=0.813) with the outcomes (13.4 ± 9.2), whereas the fractional anisotropy from a region of interest set in the cerebral peduncle on the lesion side (0.548 ± 0.064) was not significantly correlated with the outcomes (r=0.507). [Conclusion] The findings suggest that fractional anisotropy derived from standardized automated tractography can be more applicable to outcome prediction than that derived from a region of interest defined in the standard brain.
Collapse
Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu
Neurosurgical Hospital: 11-1 Imazu-Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan
- Department of Rehabilitation Medicine, Hyogo Medical
University, Japan
| | - Midori Mochizuki
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu
Neurosurgical Hospital: 11-1 Imazu-Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo Medical
University, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical
University, Japan
| |
Collapse
|
3
|
Mochizuki M, Uchiyama Y, Domen K, Koyama T. Automated Tractography for the Assessment of Aphasia in Acute Care Stroke Rehabilitation: A Case Series. Prog Rehabil Med 2023; 8:20230041. [PMID: 38024960 PMCID: PMC10661235 DOI: 10.2490/prm.20230041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Aphasia is a common disorder among stroke patients. Assessment of aphasia is essential for scheduling appropriate rehabilitative treatment. Although this is conventionally accomplished using neuropsychological test batteries, these tests are not always accessible because of attention and/or consciousness disturbances during acute care. To overcome this issue, we have introduced a newly developed automated tractography known as XTRACT. Cases Diffusion-tensor images were acquired from three patients on days 10-14. Brain images were processed by XTRACT, which automatically extracts neural tracts using standardized protocols. Fractional anisotropy (FA) values were then bilaterally evaluated in the following neural tracts associated with aphasia: arcuate fasciculus, inferior fronto-occipital fasciculus, middle longitudinal fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus. Case 1 had word-finding difficulty on admission. FA values in the lesioned left hemisphere were not decreased in all tracts and this patient fully recovered during acute care. Case 2 had reduced spontaneous speech and a low FA value in the left arcuate fasciculus. Rehabilitative treatment was scheduled to improve the verbal output of sentences and word recall. Case 3 could not complete the conventional aphasia test battery because of attention disturbance. He had low FA values in all tracts in the left hemisphere. Rehabilitative treatment was designed to focus on both speaking and auditory comprehension. Discussion Automated tractography enables quantitative assessment of the neural damage associated with aphasia, even in patients with attention and/or consciousness disturbances. This modality can aid in the assessment of aphasia and allows the planning of appropriate rehabilitative treatment.
Collapse
Affiliation(s)
- Midori Mochizuki
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Japan
| |
Collapse
|
4
|
Domin M, Hordacre B, Hok P, Boyd LA, Conforto AB, Andrushko JW, Borich MR, Craddock RC, Donnelly MR, Dula AN, Warach SJ, Kautz SA, Lo BP, Schranz C, Seo NJ, Srivastava S, Wong KA, Zavaliangos-Petropulu A, Thompson PM, Liew SL, Lotze M. White Matter Integrity and Chronic Poststroke Upper Limb Function: An ENIGMA Stroke Recovery Analysis. Stroke 2023; 54:2438-2441. [PMID: 37465999 PMCID: PMC10529837 DOI: 10.1161/strokeaha.123.043713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Integrity of the corticospinal tract (CST) is an important biomarker for upper limb motor function following stroke. However, when structurally compromised, other tracts may become relevant for compensation or recovery of function. METHODS We used the ENIGMA Stroke Recovery data set, a multicenter, retrospective, and cross-sectional collection of patients with upper limb impairment during the chronic phase of stroke to test the relevance of tracts in individuals with less and more severe (laterality index of CST fractional anisotropy ≥0.25) CST damage in an observational study design. White matter integrity was quantified using fractional anisotropy for the CST, the superior longitudinal fascicle, and the callosal fibers interconnecting the primary motor cortices between hemispheres. Optic radiations served as a control tract as they have no a priori relevance for the motor system. Pearson correlation was used for testing correlation with upper limb motor function (Fugl-Meyer upper extremity). RESULTS From 1235 available data sets, 166 were selected (by imaging, Fugl-Meyer upper extremity, covariates, stroke location, and stage) for analyses. Only individuals with severe CST damage showed a positive association of fractional anisotropy in both callosal fibers interconnecting the primary motor cortices (r[21]=0.49; P=0.025) and superior longitudinal fascicle (r[21]=0.51; P=0.018) with Fugl-Meyer upper extremity. CONCLUSIONS Our data support the notion that individuals with more severe damage of the CST depend on residual pathways for achieving better upper limb outcome than those with less affected CST.
Collapse
Affiliation(s)
- Martin Domin
- Functional Imaging Unit, Diagnostic and Neuroradiology, University Hospital Greifswald, Greifswald, Germany
| | - Brenton Hordacre
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Pavel Hok
- Functional Imaging Unit, Diagnostic and Neuroradiology, University Hospital Greifswald, Greifswald, Germany
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriana B Conforto
- Hospital das Clínicas, São Paulo University, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Justin W Andrushko
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Borich
- Department of Rehabilitation Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Richard C Craddock
- Department of Diagnostic Medicine, The University of Texas at Austin, Austin, TX, USA
| | - Miranda R Donnelly
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Adrienne N Dula
- Department of Neurology, Dell Medical School at The University of Texas Austin, Austin, TX, USA
| | - Steven J Warach
- Department of Neurology, Dell Medical School at The University of Texas Austin, Austin, TX, USA
| | - Steven A Kautz
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC, USA
| | - Bethany P Lo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Christian Schranz
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Na Jin Seo
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC, USA
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Shraddha Srivastava
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
| | - Kristin A Wong
- Department of Physical Medicine & Rehabilitation, The University of Texas at Austin, Austin, TX, USA
| | - Artemis Zavaliangos-Petropulu
- Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Sook-Lei Liew
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Martin Lotze
- Functional Imaging Unit, Diagnostic and Neuroradiology, University Hospital Greifswald, Greifswald, Germany
| |
Collapse
|
5
|
Brunelli S, Giannella E, Bizzaglia M, De Angelis D, Sancesario GM. Secondary neurodegeneration following Stroke: what can blood biomarkers tell us? Front Neurol 2023; 14:1198216. [PMID: 37719764 PMCID: PMC10502514 DOI: 10.3389/fneur.2023.1198216] [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: 03/31/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Stroke is one of the leading causes of death and the primary source of disability in adults, resulting in neuronal necrosis of ischemic areas, and in possible secondary degeneration of regions surrounding or distant to the initial damaged area. Secondary neurodegeneration (SNDG) following stroke has been shown to have different pathogenetic origins including inflammation, neurovascular response and cytotoxicity, but can be associated also to regenerative processes. Aside from focal neuronal loss, ipsilateral and contralateral effects distal to the lesion site, disruptions of global functional connectivity and a transcallosal diaschisis have been reported in the chronic stages after stroke. Furthermore, SNDG can be observed in different areas not directly connected to the primary lesion, such as thalamus, hippocampus, amygdala, substantia nigra, corpus callosum, bilateral inferior fronto-occipital fasciculus and superior longitudinal fasciculus, which can be highlighted by neuroimaging techniques. Although the clinical relevance of SNDG following stroke has not been well understood, the identification of specific biomarkers that reflect the brain response to the damage, is of paramount importance to investigate in vivo the different phases of stroke. Actually, brain-derived markers, particularly neurofilament light chain, tau protein, S100b, in post-stroke patients have yielded promising results. This review focuses on cerebral morphological modifications occurring after a stroke, on associated cellular and molecular changes and on state-of-the-art of biomarkers in acute and chronic phase. Finally, we discuss new perspectives regarding the implementation of blood-based biomarkers in clinical practice to improve the rehabilitation approaches and post stroke recovery.
Collapse
Affiliation(s)
- Stefano Brunelli
- NeuroRehabilitation Unit 4, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Emilia Giannella
- Clinical Neurochemistry Unit and Biobank, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mirko Bizzaglia
- Radiology and Diagnostic Imaging Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | | |
Collapse
|
6
|
Uchiyama Y, Domen K, Koyama T. Brain regions associated with Brunnstrom and functional independence measure scores in patients after a stroke: a tract-based spatial statistics study. J Phys Ther Sci 2023; 35:211-216. [PMID: 36866011 PMCID: PMC9974314 DOI: 10.1589/jpts.35.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/06/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] We aimed to assess diffusion tensor fractional anisotropy to outline the brain regions associated with the long-term motor and cognitive functional outcomes of patients with stroke. [Participants and Methods] Eighty patients from our previous study were enrolled. Fractional anisotropy maps were acquired on days 14-21 after stroke onset, and tract-based spatial statistics were applied. Outcomes were scored using the Brunnstrom recovery stage and Functional Independence Measure motor and cognition components. Fractional anisotropy images were assessed in relation to outcome scores using the general linear model. [Results] For both the right (n=37) and left (n=43) hemisphere lesion groups, the corticospinal tract and the anterior thalamic radiation were most strongly associated with the Brunnstrom recovery stage. In contrast, the cognition component involved large regions encompassing the anterior thalamic radiation, superior longitudinal fasciculus, inferior longitudinal fasciculus, uncinate fasciculus, cingulum bundle, forceps major, and forceps minor. The results for the motor component were intermediate between those for the Brunnstrom recovery stage and those for the cognition component. [Conclusion] Motor-related outcomes were associated with fractional anisotropy decreases in the corticospinal tract, whereas cognitive outcomes were related to broad regions of association and commissural fibers. This knowledge will help scheduling appropriate rehabilitative treatments.
Collapse
Affiliation(s)
- Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo Medical
University: 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan,Corresponding author. Yuki Uchiyama (E-mail: )
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical
University: 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Hyogo Medical
University: 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan, Department of Rehabilitation Medicine, Nishinomiya Kyoritsu
Neurosurgical Hospital, Japan
| |
Collapse
|
7
|
Mochizuki M, Uchiyama Y, Domen K, Koyama T. Applicability of automated tractography during acute care stroke rehabilitation. J Phys Ther Sci 2023; 35:156-162. [PMID: 36744203 PMCID: PMC9889207 DOI: 10.1589/jpts.35.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/22/2022] [Indexed: 02/04/2023] Open
Abstract
[Purpose] To assess the clinical applicability of a novel automated tractography tool named XTRACT during acute stroke rehabilitation. [Participants and Methods] Three patients with left hemisphere stroke were sampled. Diffusion tensor images were acquired on the second week, and automated tractography was then applied. Tractography images and fractional anisotropy (FA) values in the corticospinal tract (CST) and arcuate fasciculus (AF) were assessed in relation to hemiparesis and aphasia. [Results] Patient 1 was nearly asymptomatic; FA in the left CST was 0.610 and that in the AF was 0.509. Patient 2 had severe hemiparesis and mild motor aphasia. Tractography images of the CST and AF were blurred; FA in the left CST was 0.295 and that in the AF was 0.304. Patient 3 showed no hemiparesis or aphasia at initial assessment. Tractography image of the CST was intact but that of the AF was less clear; FA in the left CST was 0.586 and that in the AF was 0.338. Considering the less clear images of the AF and lower FA value in Patients 2 and 3, further examinations for aphasia were performed, which revealed agraphia. [Conclusion] Visualization and quantification of neural fibers using automated tractography promoted planning acute care rehabilitative treatment in patients with stroke.
Collapse
Affiliation(s)
- Midori Mochizuki
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu
Neurosurgical Hospital: 11-1 Imazu-Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan,Corresponding author. Midori Mochizuki (E-mail: )
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo Medical
University, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical
University, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu
Neurosurgical Hospital: 11-1 Imazu-Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan, Department of Rehabilitation Medicine, Hyogo Medical
University, Japan
| |
Collapse
|
8
|
Regenhardt RW, Bonkhoff AK, Bretzner M, Etherton MR, Das AS, Hong S, Alotaibi NM, Vranic JE, Dmytriw AA, Stapleton CJ, Patel AB, Leslie-Mazwi TM, Rost NS. Association of Infarct Topography and Outcome After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke. Neurology 2022; 98:e1094-e1103. [PMID: 35101908 PMCID: PMC8935439 DOI: 10.1212/wnl.0000000000200034] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The care of patients with large vessel occlusion (LVO) stroke has been revolutionized by endovascular thrombectomy (EVT). While EVT has a large effect size, most patients treated with EVT remain disabled or die within 90 days. A better understanding of outcomes may influence EVT selection criteria, novel therapies, and prognostication. We sought to identify associations between outcomes and brain regions involved in ischemic lesions. METHODS For this cohort study, consecutive patients with LVO who were treated with EVT and underwent post-EVT MRI were identified from a tertiary referral center (2011-2019). Acute ischemic lesions were manually segmented from diffusion-weighted imaging and spatially normalized. Individual lesions were parcellated (atlas-defined 94 cortical regions, 14 subcortical nuclei, 20 white matter tracts) and reduced to 10 essential lesion patterns with the use of unsupervised dimensionality reduction techniques. Ninety-day modified Rankin Scale (mRS) score (>2) was modeled via bayesian regression, taking the 10 lesion patterns as inputs and controlling for lesion size, age, sex, acute NIH Stroke Scale (NIHSS) score, alteplase, prior stroke, intracerebral hemorrhage, and good reperfusion (Thrombolysis in Cerebral Infarction 2b-3). In comparative analyses, 90-day mRS score was modeled considering covariates only, and compartment-wise relevances for acute stroke severity and 90-day mRS score were evaluated. RESULTS There were 151 patients with LVO identified (age 68 ± 15 years, 52% female). The median NIHSS score was 16 (interquartile range 13-20); 56% had mRS score >2. Lesion locations predictive of 90-day mRS score involved bilateral but left hemispherically more pronounced precentral and postcentral gyri, insular and opercular cortex, and left putamen and caudate (area under the curve 0.91, highest probability density interval [HPDI] covering 90% certainty 0.90-0.92). The lesion location model outperformed the simpler model relying on covariates only (bayesian model comparison of 97% weight to the model with vs 3% weight to the model without lesion location). While lesions affecting subcortical nuclei had the highest relevance for stroke severity (posterior distribution mean 0.75, 90% HPDI 0.256-1.31), lesions affecting white matter tracts had the highest relevance for 90-day mRS score (0.656, 90% HPDI 0.0864-1.12). DISCUSSION These data describe the significance for outcomes of specific brain regions involved in ischemic lesions on MRI after EVT. Future work in additional datasets is needed to confirm these granular findings.
Collapse
Affiliation(s)
- Robert W Regenhardt
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Anna K Bonkhoff
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Martin Bretzner
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Mark R Etherton
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alvin S Das
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sungmin Hong
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Naif M Alotaibi
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Justin E Vranic
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Adam A Dmytriw
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Christopher J Stapleton
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Aman B Patel
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Thabele M Leslie-Mazwi
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Natalia S Rost
- From the Departments of Neurology (R.W.R., A.K.B., M.B., M.R.E., A.S.D., S.H., T.M.L.-M., N.S.R.), Neurosurgery (R.W.R., N.M.A., J.E.V., A.A.D., C.J.S., A.B.P., T.M.L.-M.), and Radiology (J.E.V., A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
9
|
Uchida K, Uchiyama Y, Domen K, Koyama T. Outcome Prediction for Patients With Ischemic Stroke in Acute Care: New Three-Level Model by Eating and Bladder Functions. Ann Rehabil Med 2021; 45:215-223. [PMID: 34126671 PMCID: PMC8273726 DOI: 10.5535/arm.20226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/11/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To develop a new prediction model by combining independence in eating and bladder management functions, and to assess its utility in an acute care setting. METHODS Patients with ischemic stroke who were admitted in our acute stroke care unit (n=250) were enrolled in this study. Functional Independence Measure (FIM) scores for eating and bladder management on the initial day of rehabilitative treatment (median, 3 days) were collected as predictive variables. These scores were divided into low (<5) and high (≥5) and categorized as values 0 and 1, respectively. From the simple summation of these two-level model values, we derived a three-level model that categorized the scores as values 0, 1, and 2. The FIM-motor scores at discharge (median, 14 days) were collected as outcome measurements. The three-level model was assessed by observing the distribution patterns of the outcome FIM-motor scores and logistic regression analyses. RESULTS The median outcome FIM-motor score was 19 (interquartile range [IQR],13.8-45.3) for the value 0 category (n=14), 66.5 (IQR, 59.5-81.8) for the value 1 category (n=16), and 84 (IQR, 77-89) for the value 2 category (n=95) in the three-level model. Data fitting by logistic regression for FIM-motor scores of 41.3 and 61.4 reached 50% probability of values 1 and 2, respectively. CONCLUSION Despite the simplicity of the three-level model, it may be useful for predicting outcomes of patients with ischemic stroke in acute care.
Collapse
Affiliation(s)
- Kensaku Uchida
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.,Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| |
Collapse
|
10
|
Uchida K, Uchiyama Y, Domen K, Koyama T. Item Difficulties of the FIM-Motor Subscale in Patients with Ischemic Stroke during Acute Care: An Ordinal Logistic Modeling Study. Prog Rehabil Med 2020; 5:20200022. [PMID: 32999943 PMCID: PMC7516197 DOI: 10.2490/prm.20200022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/15/2020] [Indexed: 01/01/2023] Open
Abstract
Objective: The aim of the current study was to assess the item difficulties of the motor subscales of the Functional Independence Measure (FIM-motor) in patients with ischemic stroke during acute care. Methods: FIM scores were assessed for each patient on admission to, and discharge from, acute care. The relationship between individual FIM-motor items (target variables) and the total FIM-motor score (explanatory variable) was assessed by ordinal logistic modeling. The total FIM-motor scores that corresponded to a 50% probability of independence level 5 (supervision or setup) for each FIM-motor item were assessed. Results: A total of 250 patients (155 men, 95 women) were included in the analytical database. The median age was 74 (interquartile range [IQR], 66–81) years and the median length of hospital stay was 14 (IQR, 10–24) days. Ordinal logistic modeling was successfully performed for all 13 FIM-motor items. The total FIM-motor scores that corresponded to a 50% probability of independence level 5 for individual FIM-motor items were as follows: eating, 34.1; bowel management, 42.2; bladder management, 43.4; grooming, 51.0; toileting, 62.0; dressing the lower body, 64.5; transfer to bed/chair/wheelchair, 65.5; transfer to toilet, 65.9; bathing, 70.3; dressing the upper body, 73.6; locomotion, 74.2; transfer to tub/shower, 80.0; and stair climbing, 89.2. Conclusions: These results revealed that eating, grooming, and bowel and bladder management were relatively easy, whereas gait-related items such as locomotion and stair climbing were difficult. Items such as transfer to bed/chair/wheelchair and toileting had intermediate difficulty. These results should facilitate efficient rehabilitative treatments during acute care.
Collapse
Affiliation(s)
- Kensaku Uchida
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| |
Collapse
|
11
|
Sotelo MR, Kalinosky BT, Goodfriend K, Hyngstrom AS, Schmit BD. Indirect Structural Connectivity Identifies Changes in Brain Networks After Stroke. Brain Connect 2020; 10:399-410. [PMID: 32731752 DOI: 10.1089/brain.2019.0725] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background/Purpose: The purpose of this study was (1) to identify changes in structural connectivity after stroke and (2) to relate changes in indirect connectivity to post-stroke impairment. Methods: A novel measure of indirect connectivity was implemented to assess the impact of stroke on brain connectivity. Probabilistic tractography was performed on 13 chronic stroke and 16 control participants to estimate connectivity between gray matter (GM) regions. The Fugl-Meyer assessment of motor impairment was measured for stroke participants. Network measures of direct and indirect connectivity were calculated, and these measures were linearly combined with measures of white matter integrity to predict motor impairment. Results: We found significantly reduced indirect connectivity in the frontal and parietal lobes, ipsilesional subcortical regions, and bilateral cerebellum after stroke. When added to the regression analysis, the volume of GM with reduced indirect connectivity significantly improved the correlation between image parameters and upper extremity motor impairment (R2 = 0.71, p < 0.05). Conclusion: This study provides evidence of changes in indirect connectivity in regions remote from the lesion, particularly in the cerebellum and regions in the fronto-parietal cortices, and these changes correlate with upper extremity motor impairment. These results highlight the value of using measures of indirect connectivity to identify the effect of stroke on brain networks. Impact statement Changes in indirect structural connectivity occur in regions distant from a lesion after stroke, highlighting the impact that stroke has on brain functional networks. Specifically, losses in indirect structural connectivity occur in hubs with high centrality, including the fronto-parietal cortices and cerebellum. These losses in indirect connectivity more accurately reflect motor impairments than measures of direct structural connectivity. As a consequence, indirect structural connectivity appears to be important to recovery after stroke and imaging biomarkers that incorporate indirect structural connectivity might improve prognostication of stroke outcomes.
Collapse
Affiliation(s)
- Miguel R Sotelo
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Benjamin T Kalinosky
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Karin Goodfriend
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Allison S Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
12
|
Egorova N, Dhollander T, Khlif MS, Khan W, Werden E, Brodtmann A. Pervasive White Matter Fiber Degeneration in Ischemic Stroke. Stroke 2020; 51:1507-1513. [PMID: 32295506 DOI: 10.1161/strokeaha.119.028143] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose- We examined if ischemic stroke is associated with white matter degeneration predominantly confined to the ipsi-lesional tracts or with widespread bilateral axonal loss independent of lesion laterality. Methods- We applied a novel fixel-based analysis, sensitive to fiber tract-specific differences within a voxel, to assess axonal loss in stroke (N=104, 32 women) compared to control participants (N=40, 15 women) across the whole brain. We studied microstructural differences in fiber density and macrostructural (morphological) changes in fiber cross-section. Results- In participants with stroke, we observed significantly lower fiber density and cross-section in areas adjacent, or connected, to the lesions (eg, ipsi-lesional corticospinal tract). In addition, the changes extended beyond directly connected tracts, independent of the lesion laterality (eg, corpus callosum, bilateral inferior fronto-occipital fasciculus, right superior longitudinal fasciculus). Conclusions- We conclude that ischemic stroke is associated with extensive neurodegeneration that significantly affects white matter integrity across the whole brain. These findings expand our understanding of the mechanisms of brain volume loss and delayed cognitive decline in stroke.
Collapse
Affiliation(s)
- Natalia Egorova
- From the Dementia Research Theme, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia (N.E., M.S.K., W.K., E.W., A.B.).,Melbourne School of Psychological Sciences, University of Melbourne, Australia (N.E., A.B.)
| | - Thijs Dhollander
- Developmental Imaging Research Theme, Murdoch Children's Research Institute, Melbourne, Australia (T.D.)
| | - Mohamed Salah Khlif
- From the Dementia Research Theme, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia (N.E., M.S.K., W.K., E.W., A.B.)
| | - Wasim Khan
- From the Dementia Research Theme, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia (N.E., M.S.K., W.K., E.W., A.B.).,Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, United Kingdom (W.K.)
| | - Emilio Werden
- From the Dementia Research Theme, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia (N.E., M.S.K., W.K., E.W., A.B.)
| | - Amy Brodtmann
- From the Dementia Research Theme, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia (N.E., M.S.K., W.K., E.W., A.B.).,Melbourne School of Psychological Sciences, University of Melbourne, Australia (N.E., A.B.)
| |
Collapse
|
13
|
Koyama T, Uchiyama Y, Domen K. Outcome in Stroke Patients Is Associated with Age and Fractional Anisotropy in the Cerebral Peduncles: A Multivariate Regression Study. Prog Rehabil Med 2020; 5:20200006. [PMID: 32789274 PMCID: PMC7365210 DOI: 10.2490/prm.20200006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/23/2020] [Indexed: 01/16/2023] Open
Abstract
Objectives: Diffusion tensor fractional anisotropy (FA) in the corticospinal tracts has been used
to assess the long-term outcome in stroke patients. Patient age and the type of stroke
may also affect outcomes. In this study, we investigated the associations of age, type
of stroke, and FA in the ipsilesional and contralesional cerebral peduncles with stroke
outcomes. Methods: This study involved 80 patients with stroke (40 hemorrhagic, 40 ischemic) that we had
investigated previously. Diffusion tensor FA images were obtained between 14 and 21 days
post-stroke. FA values in the ipsilesional and contralesional cerebral peduncles were
extracted and their ratio (rFA) was calculated. Outcome was assessed using the
Brunnstrom stage, the motor component of the Functional Independence Measure (FIM-motor)
at discharge, and the length of stay until discharge from rehabilitation. Using forward
stepwise multivariate regression, we assessed the associations of rFA, contralesional
FA, age, and type of stroke with outcome measures. Results: rFA and contralesional FA were included in the final model for the Brunnstrom stage in
the upper limbs. There was a strong association between hemorrhagic stroke and poorer
lower extremity function. rFA, contralesional FA, and age were included in the final
model for FIM-motor and length of stay. The effect of rFA on all outcome measures was
stronger than that of contralesional FA. The effect of age on FIM-motor was as strong as
that of rFA. Conclusions: Neural damage in the corticospinal tracts (indicated by rFA) had the strongest effect
on outcome measures, whereas the level of disability (measured by FIM-motor) was
associated with a broader range of factors, including age.
Collapse
Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan.,Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| |
Collapse
|
14
|
Koyama T, Uchiyama Y, Domen K. Comparison of Fractional Anisotropy from Tract-Based Spatial Statistics with and without Lesion Masking in Patients with Intracerebral Hemorrhage: A Technical Note. J Stroke Cerebrovasc Dis 2019; 28:104376. [PMID: 31530481 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/27/2019] [Accepted: 08/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diffusion-tensor fractional anisotropy (FA) is an index of neural-fiber damage in patients following stroke. To better characterize FA, tract-based spatial statistics (TBSS) is frequently used, which involves spatial transformation into the standard brain space. Despite its utility, this technique is susceptible to space-occupying hematoma in patients with intracerebral hemorrhage. To correct this, "lesion making" has been proposed. Here, FA values from TBSS without lesion masking and TBSS with lesion masking were compared, and the clinical utility was evaluated. METHODS Forty patients from our previously published work were entered into the study. Diffusion-tensor imagings were acquired 14-21 days after onset and FA maps were generated. Lesion masks were produced in reference with nondiffusion (b = 0) brain images. Two types (with or without lesion masking) of TBSS were then performed. For both types, using individual data we extracted mean FA values within for the corticospinal tract (CST) and the superior longitudinal fasciculus (SLF). FA ratio (rFA) between the lesioned hemisphere and the unaffected hemisphere was then calculated. The two sets of the data were then compared by assessing residuals of mean root sum square error (RMSE). RESULTS Although rFA obtained from TBSS with lesion masking tended to be slightly smaller, the estimated RMSE was .025 for both the CST and the SLF. CONCLUSIONS The estimated FA differences between the two sets of TBSS were very small. Considering the time for manual labor for producing lesion masks, regular TBSS without lesion masking may be sufficient in terms of clinical utility.
Collapse
Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan; Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Zhao Y, Wang H, Chen W, Chen L, Liu D, Wang X, Wang X. Melatonin attenuates white matter damage after focal brain ischemia in rats by regulating the TLR4/NF-κB pathway. Brain Res Bull 2019; 150:168-178. [PMID: 31158461 DOI: 10.1016/j.brainresbull.2019.05.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/08/2019] [Accepted: 05/23/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the possible neuroprotective effects of melatonin against brain white matter damage via the Toll-like receptor 4 (TLR4)/ nuclear factor-kappa B (NF-κB) signaling pathway in focal cerebral ischemic rats. METHODS Fifty-four Sprague-Dawley rats were randomly divided into the Sham, middle cerebral artery occlusion (MCAO), and melatonin groups. The successful MCAO models were evaluated by Laser Doppler flowmetry, magnetic resonance imaging (MRI) with T2-weighted imaging (T2WI) examination and 2, 3, 5-triphenyltetrazolium chloride (TTC) staining. White matter damage was assessed by myelin basic protein (MBP) immunohistochemical, Luxol Fast Blue (LFB) staining, and diffusion tensor imaging (DTI) examination. The proliferation of oligodendrocyte progenitor cells (OPCs) was examined by proliferating cell nuclear antigen (PCNA)/neural glial antigen 2 (NG2)/DAPI immunofluorescent staining. And the effects of melatonin therapy on the TLR4, NF-κB, and interleukin (IL)-1β proteins were examined by immunohistochemical staining. The correlation between the proliferating OPCs and TLR4 protein, IL-1β and TLR4 protein was respectively analyzed by linear regression analysis. RESULTS The infarct volume was significantly reduced and white matter damage was also significantly alleviated in the melatonin group as compared with the MCAO group (P < 0.05), and there were more TLR4+, NF-κB+ and IL-1β+ cells in the MCAO group compared with the melatonin group (P < 0.01). Similarly, more PCNA+NG2+ cells were observed in the subventricular zone and white matter areas in the melatonin group compared with the MCAO group (P < 0.01). The number of TLR4+ cells was closely positively correlated with that of IL-1β+ cells, and negatively correlated with that of PCNA+NG2+ cells. CONCLUSIONS In summary, melatonin could promote the proliferation of endogenous OPCs and suppress the expression of IL-1β protein via inhibiting TLR4/NF-κB signaling, thus alleviate the white matter damage in focal cerebral ischemic rats.
Collapse
Affiliation(s)
- Yansong Zhao
- Department of Ophthalmology, Affiliated Hospital, Weifang Medical University, Weifang, Shandong 261031, China.
| | - Haiyu Wang
- Department of Medical Imaging, Rizhao Traditional Chinese Hospital, Rizhao, Shandong 276800, China
| | - Wei Chen
- Department of Medical Imaging, Weifang Medical University, Weifang, Shandong 261053, China
| | - Lanfen Chen
- Department of Medical Imaging, Weifang Medical University, Weifang, Shandong 261053, China
| | - Dianmei Liu
- Department of Medical Imaging, Weifang Medical University, Weifang, Shandong 261053, China
| | - Xin Wang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xiaoli Wang
- Department of Medical Imaging, Weifang Medical University, Weifang, Shandong 261053, China.
| |
Collapse
|
17
|
Koyama T, Uchiyama Y, Domen K. Associations of Diffusion-Tensor Fractional Anisotropy and FIM Outcome Assessments After Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:2869-2876. [PMID: 30072174 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/20/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
AIM This study aimed to clarify the associations between fiber tract degeneration evaluated by diffusion-tensor imaging (DTI) and outcomes following intracerebral hemorrhage (ICH). METHODS In total, data of 40 patients from our previously published reports were assessed. Acquisition of fractional anisotropy (FA) maps was performed using DTI 14-21 days after onset; tract-based spatial statistics (TBSS) was used for the analysis. Mean FA values within the corticospinal tract (CST), the superior longitudinal fasciculus (SLF), the inferior longitudinal fasciculus, and the uncinate fasciculus were extracted from individual TBSS data. By using multivariate regression analysis, ratios of FA between lesioned and nonlesioned hemispheres were modeled to fit outcomes assessed by Brunnstrom stage (BRS) shoulder/elbow/forearm, hand/finger, and lower extremity functions and Functional Independence Measure (FIM) motor and cognition scores. RESULTS Multivariate regression analyses only took the CST data into the final models for FIM-motor (adjusted R2 = .145), BRS shoulder/elbow/forearm, hand/finger, and lower extremity outcomes (adjusted R2 = .485, .503, and .425, respectively). In contrast, only the SLF data were taken into the final model for the FIM-cognition outcomes (adjusted R2 = .177). CONCLUSIONS Fiber tract degeneration in the CST mainly affected motor-related outcomes such as FIM-motor and affected extremity functions assessed by using BRS, whereas that in the SLF associated with poorer cognition-related outcomes. These findings imply that, by using DTI, outcomes of patients after ICH may be predictable by assessing fiber tract degeneration in the CST and the SLF.
Collapse
Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan; Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|