1
|
Christidi F, Tsiptsios D, Fotiadou A, Kitmeridou S, Karatzetzou S, Tsamakis K, Sousanidou A, Psatha EA, Karavasilis E, Seimenis I, Kokkotis C, Aggelousis N, Vadikolias K. Diffusion Tensor Imaging as a Prognostic Tool for Recovery in Acute and Hyperacute Stroke. Neurol Int 2022; 14:841-874. [PMID: 36278693 PMCID: PMC9589952 DOI: 10.3390/neurolint14040069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Stroke represents a major cause of mortality and long-term disability among adult populations, leaving a devastating socioeconomic impact globally. Clinical manifestation of stroke is characterized by great diversity, ranging from minor disability to considerable neurological impairment interfering with activities of daily living and even death. Prognostic ambiguity has stimulated the interest for implementing stroke recovery biomarkers, including those provided by structural neuroimaging techniques, i.e., diffusion tensor imaging (DTI) and tractography for the study of white matter (WM) integrity. Considering the necessity of prompt and accurate prognosis in stroke survivors along with the potential capacity of DTI as a relevant imaging biomarker, the purpose of our study was to review the pertinent literature published within the last decade regarding DTI as a prognostic tool for recovery in acute and hyperacute stroke. We conducted a thorough literature search in two databases (MEDLINE and Science Direct) in order to trace all relevant studies published between 1 January 2012 and 16 March 2022 using predefined terms as key words. Only full-text human studies published in the English language were included. Forty-four studies were identified and are included in this review. We present main findings and by describing several methodological issues, we highlight shortcomings and gaps in the current literature so that research priorities for future research can be outlined. Our review suggests that DTI can track longitudinal changes and identify prognostic correlates in acute and hyperacute stroke patients.
Collapse
Affiliation(s)
- Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Aggeliki Fotiadou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Stella Karatzetzou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK
| | - Anastasia Sousanidou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Evlampia A. Psatha
- Department of Radiology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University, 11527 Athens, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| |
Collapse
|
2
|
Liu G, Guo Y, Dang C, Peng K, Tan S, Xie C, Xing S, Zeng J. Longitudinal changes in the inferior cerebellar peduncle and lower limb motor recovery following subcortical infarction. BMC Neurol 2021; 21:320. [PMID: 34404371 PMCID: PMC8369783 DOI: 10.1186/s12883-021-02346-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/06/2021] [Indexed: 02/02/2023] Open
Abstract
Background The cerebellum receives afferent signals from spinocerebellar pathways regulating lower limb movements. However, the longitudinal changes in the spinocerebellar pathway in the early stage of unilateral supratentorial stroke and their potential clinical significance have received little attention. Methods Diffusion tensor imaging and Fugl-Meyer assessment of lower limb were performed 1, 4, and 12 weeks after onset in 33 patients with acute subcortical infarction involving the supratentorial areas, and in 33 healthy subjects. We evaluated group differences in diffusion metrics in the bilateral inferior cerebellar peduncle (ICP) and analyzed the correlation between ICP diffusion metrics and changes to the Fugl-Meyer scores of the affected lower limb within 12 weeks after stroke. Results Significantly decreased fractional anisotropy and increased mean diffusivity were found in the contralesional ICP at week 12 after stroke compared to controls (all P < 0.01) and those at week 1 (all P < 0.05). There were significant fractional anisotropy decreases in the ipsilesional ICP at week 4 (P = 0.008) and week 12 (P = 0.004) compared to controls. Both fractional anisotropy (rs = 0.416, P = 0.025) and mean diffusivity (rs = -0.507, P = 0.005) changes in the contralesional ICP correlated with changes in Fugl-Meyer scores of the affected lower limb in all patients. Conclusions Bilateral ICP degeneration occurs in the early phase of supratentorial stroke, and diffusion metric values of the contralesional ICP are useful indicators of affected lower limb function after supratentorial stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02346-x.
Collapse
Affiliation(s)
- Gang Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, Guangdong, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, Guangdong, China
| | - Yaomin Guo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, Guangdong, China
| | - Chao Dang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, Guangdong, China
| | - Kangqiang Peng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shuangquan Tan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, Guangdong, China
| | - Chuanmiao Xie
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shihui Xing
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, Guangdong, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No. 58, Zhongshan Road 2, Guangzhou, Guangdong, China.
| |
Collapse
|
3
|
Sun C, Liu X, Bao C, Wei F, Gong Y, Li Y, Liu J. Advanced non-invasive MRI of neuroplasticity in ischemic stroke: Techniques and applications. Life Sci 2020; 261:118365. [PMID: 32871181 DOI: 10.1016/j.lfs.2020.118365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/27/2022]
Abstract
Ischemic stroke represents a serious medical condition which could cause survivors suffer from long-term and even lifetime disabilities. After a stroke attack, the brain would undergo varying degrees of recovery, in which the central nervous system could be reorganized spontaneously or with the help of appropriate rehabilitation. Magnetic resonance imaging (MRI) is a non-invasive technique which can provide comprehensive information on structural, functional and metabolic features of brain tissue. In the last decade, there has been an increased technical advancement in MR techniques such as voxel-based morphological analysis (VBM), diffusion magnetic resonance imaging (dMRI), functional magnetic resonance imaging (fMRI), arterial spin-labeled perfusion imaging (ASL), magnetic sensitivity weighted imaging (SWI), quantitative sensitivity magnetization (QSM) and magnetic resonance spectroscopy (MRS) which have been proven to be a valuable tool to study the brain tissue reorganization. Due to MRI indices of neuroplasticity related to neurological outcome could be translated to the clinic. The ultimate goal of this review is to equip readers with a fundamental understanding of advanced MR techniques and their corresponding clinical application for improving the ability to predict neuroplasticity that are most suitable for stroke management.
Collapse
Affiliation(s)
- Chao Sun
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China
| | - Xuehuan Liu
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Cuiping Bao
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Feng Wei
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Yi Gong
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Yiming Li
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Jun Liu
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China.
| |
Collapse
|
4
|
Moulton E, Valabregue R, Lehéricy S, Samson Y, Rosso C. Multivariate prediction of functional outcome using lesion topography characterized by acute diffusion tensor imaging. Neuroimage Clin 2019; 23:101821. [PMID: 30991303 PMCID: PMC6462821 DOI: 10.1016/j.nicl.2019.101821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/07/2022]
Abstract
The relationship between stroke topography and functional outcome has largely been studied with binary manual lesion segmentations. However, stroke topography may be better characterized by continuous variables capable of reflecting the severity of ischemia, which may be more pertinent for long-term outcome. Diffusion Tensor Imaging (DTI) constitutes a powerful means of quantifying the degree of acute ischemia and its potential relation to functional outcome. Our aim was to investigate whether using more clinically pertinent imaging parameters with powerful machine learning techniques could improve prediction models and thus provide valuable insight on critical brain areas important for long-term outcome. Eighty-seven thrombolyzed patients underwent a DTI sequence at 24 h post-stroke. Functional outcome was evaluated at 3 months post-stroke with the modified Rankin Score and was dichotomized into good (mRS ≤ 2) and poor (mRS > 2) outcome. We used support vector machines (SVM) to classify patients into good vs. poor outcome and evaluate the accuracy of different models built with fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity asymmetry maps, and lesion segmentations in combination with lesion volume, age, recanalization status, and thrombectomy treatment. SVM classifiers built with axial diffusivity maps yielded the best accuracy of all imaging parameters (median [IQR] accuracy = 82.8 [79.3-86.2]%), compared to that of lesion segmentations (76.7 [73.3-82.8]%) when predicting 3-month functional outcome. The analysis revealed a strong contribution of clinical variables, notably - in descending order - lesion volume, thrombectomy treatment, and recanalization status, in addition to the deep white matter at the crossroads of major white matter tracts, represented by brain regions where model weights were highest. Axial diffusivity is a more appropriate imaging marker to characterize stroke topography for predicting long-term outcome than binary lesion segmentations.
Collapse
Affiliation(s)
- Eric Moulton
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France
| | - Romain Valabregue
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France; Centre de Neuro-Imagerie de Recherche, CENIR, ICM, Paris, France
| | - Stéphane Lehéricy
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France; Centre de Neuro-Imagerie de Recherche, CENIR, ICM, Paris, France; ICM Team Movement Investigation and Therapeutics, France; AP-HP, Department of Neuroradiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Samson
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France; AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France; ICM Team Movement Investigation and Therapeutics, France; AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France.
| |
Collapse
|