Comparing prognostic strength of acute corticospinal tract injury measured by a new diffusion tensor imaging based template approach versus common approaches.
Comparing prognostic strength of acute corticospinal tract injury measured by a new diffusion tensor imaging based template approach versus common approaches.
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DOI：
10.1016/j.jneumeth.2015.09.005
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发表时间：
2016-01-15
影响因子：
3
通讯作者：
Schaechter JD
中科院分区：
文献类型：
--
作者：
Hirai KK;Groisser BN;Copen WA;Singhal AB;Schaechter JD
严重运动障碍的急性脑卒中患者的长期运动结局难以预测。虽然基于弥散张量成像（DTI）的皮质脊髓束（CST）损伤的测量在亚急性脑卒中患者中强烈预测运动结果，但其在急性脑卒中患者中的预测价值尚不清楚。使用一种新的基于DTI的密度加权CST模板方法，我们最近证明，在中重度至重度上肢运动障碍的急性卒中患者中测量的CST损伤强烈预测6个月时肢体的运动结果。本研究比较了10例中重度至重度上肢运动障碍的急性卒中患者中CST损伤的预后强度，采用新的密度加权CST模板方法与几种常用的基于DTI的方法。与所有其他11种方法相比，使用密度加权CST模板方法测量的急性CST损伤与6个月上肢力量（rs = 0.93）、握力（rs = 0.94）和灵巧度（rs = 0.89）的绝对幅度相关性最强。相关系数的正式统计学比较显示，密度加权CST模板方法测量的急性CST损伤与6个月上肢力量、握力和灵巧度的相关性显著高于11个替代测量值中的9个、10个和6个。通过密度加权CST模板方法测量严重运动障碍的急性脑卒中患者的CST损伤可能具有预测医疗保健需求和改善临床试验设计的临床实用性。
Long-term motor outcome of acute stroke patients with severe motor impairment is difficult to predict. While measure of corticospinal tract (CST) injury based on diffusion tensor imaging (DTI) in subacute stroke patients strongly predicts motor outcome, its predictive value in acute stroke patients is unclear. Using a new DTI-based, density-weighted CST template approach, we demonstrated recently that CST injury measured in acute stroke patients with moderately-severe to severe motor impairment of the upper limb strongly predicts motor outcome of the limb at 6 months. The current study compared the prognostic strength of CST injury measured in 10 acute stroke patients with moderately-severe to severe motor impairment of the upper limb by the new density-weighted CST template approach versus several variants of commonly used DTI-based approaches. Use of the density-weighted CST template approach yielded measurements of acute CST injury that correlated most strongly, in absolute magnitude, with 6-month upper limb strength (rs = 0.93), grip (rs = 0.94) and dexterity (rs = 0.89) compared to all other 11 approaches. Formal statistical comparison of correlation coefficients revealed that acute CST injury measured by the density-weighted CST template approach correlated significantly more strongly with 6-month upper limb strength, grip and dexterity than 9, 10 and 6 of the 11 alternative measurements, respectively. Measurements of CST injury in acute stroke patients with substantial motor impairment by the density-weighted CST template approach may have clinical utility for anticipating healthcare needs and improving clinical trial design.