Lesion load of the corticospinal tract predicts motor impairment in chronic stroke.
Lesion load of the corticospinal tract predicts motor impairment in chronic stroke.
复制标题
DOI：
10.1161/strokeaha.109.577023
复制
发表时间：
2010-05
期刊：
影响因子：
8.3
通讯作者：
Schlaug G
中科院分区：
文献类型：
--
作者：
Zhu LL;Lindenberg R;Alexander MP;Schlaug G
先前的研究表明，中风后的运动障碍与病变大小和位置有关，但恢复过程中仍存在无法解释的变异性。在本研究中，我们使用病灶绘图技术与弥散张量成像相结合来定量检验以下假设：慢性中风患者的运动恢复与受病灶影响的皮质脊髓束（CST）的比例成反比。我们使用高分辨率解剖 MRI 研究了 50 名慢性中风患者，所有患者在急性期均出现中度至重度运动障碍。我们使用 Fugl-Meyer 评估 (UE-FM) 的上肢模块评估了运动障碍的程度。为了分析 CST 损伤和 UE-FM 评分之间的关系，我们通过将患者的病变图与从年龄匹配的健康受试者的扩散张量图像得出的概率束叠加来计算每个患者的 CST 病变负荷。 CST 损伤负荷是运动缺陷的重要预测因子。尽管梗塞面积与运动评分相关，但并不能显着预测损伤。我们的结果表明，中风后功能性运动缺陷的程度高度依赖于病变与 CST 的重叠，而不是病变大小本身。将来，CST 损伤负荷的自动计算可能允许更精确地预测中风后的运动障碍。
Previous studies have shown motor impairment after a stroke relates to lesion size and location, but unexplained variability in recovery still exists. In this study, we used lesion-mapping techniques in combination with diffusion tensor imaging to quantitatively test the hypothesis that motor recovery in chronic stroke patients is inversely related to the proportion of the corticospinal tract (CST) affected by the lesion. We studied 50 chronic stroke patients, all of whom presented with moderate to severe motor impairments in the acute stage, using high-resolution anatomical MRI. We evaluated the degree of motor impairment with the Upper Extremity module of the Fugl-Meyer Assessment (UE-FM). To analyze the relationship between CST damage and UE-FM scores, we calculated a CST-lesion load for each patient by overlaying the patient’s lesion map with a probabilistic tract derived from diffusion tensor images of age-matched healthy subjects. CST-lesion load was a significant predictor of motor deficit. Infarct size, despite correlating with motor scores, did not significantly predict impairment. Our results show the degree of functional motor deficit after a stroke is highly dependent on the overlap of lesions with the CST, and not lesion size per se. In the future, automated calculation of CST-lesion load may allow more precise prediction of motor impairment after stroke.