Influence of Stroke Infarct Location on Functional Outcome Measured by the Modified Rankin Scale
Influence of Stroke Infarct Location on Functional Outcome Measured by the Modified Rankin Scale
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DOI：
10.1161/strokeaha.114.005152
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发表时间：
2014-06-01
期刊：
影响因子：
8.3
通讯作者：
Thomalla, Goetz
中科院分区：
文献类型：
--
作者：
Cheng, Bastian;Forkert, Nils Daniel;Thomalla, Goetz
背景和目的——在缺血性中风后的早期，MRI 提供的结构性脑损伤信息支持功能结果的预后。改良的兰金量表对其进行了广泛的评价，该量表与病变体积仅中度相关。因此，我们的目的是使用基于体素的病变症状图来阐明早期 MRI（第 2-3 天）的病变位置对 1 个月后功能结果的影响。方法 - 我们分析了来自欧洲前瞻性多中心中风成像研究 (I-KNOW) 的患者的临床和 MRI 数据。中风发作后第 2 至 3 天，在液体衰减反转恢复图像上描绘病变。 1 个月后，我们使用基于体素的病变症状映射生成了与临床结果相关的病变贡献统计图（改良 Rankin 量表）。结果 - 101 名大脑中动脉梗塞患者的病变图纳入分析（右侧中风，47%）。平均年龄为 67 岁，入院美国国立卫生研究院卒中量表中位数为 11。两侧的平均梗塞体积相当（左，37.5 mL；右，43.7 mL）。基于体素的病变症状映射揭示了涉及放射冠、内囊和岛叶的区域中对更高改良Rankin量表影响较大的区域。此外，还发现了涉及右侧颞下回和左侧颞上回的不对称分布的撞击模式。结论——在这组中风患者中，早期 MRI 发现运动控制区域和涉及偏侧脑功能的区域的特征性病变模式会影响功能结果。我们的数据提供了一幅新的图谱，显示了病变定位对功能性中风结果的影响（通过改良的兰金量表测量）。
Background and Purpose-In the early days after ischemic stroke, information on structural brain damage from MRI supports prognosis of functional outcome. It is rated widely by the modified Rankin Scale that correlates only moderately with lesion volume. We therefore aimed to elucidate the influence of lesion location from early MRI (days 2-3) on functional outcome after 1 month using voxel-based lesion symptom mapping.Methods-We analyzed clinical and MRI data of patients from a prospective European multicenter stroke imaging study (I-KNOW). Lesions were delineated on fluid-attenuated inversion recovery images on days 2 to 3 after stroke onset. We generated statistic maps of lesion contribution related to clinical outcome (modified Rankin Scale) after 1 month using voxel-based lesion symptom mapping.Results-Lesion maps of 101 patients with middle cerebral artery infarctions were included for analysis (right-sided stroke, 47%). Mean age was 67 years, median admission National Institutes of Health Stroke Scale was 11. Mean infarct volumes were comparable between both sides (left, 37.5 mL; right, 43.7 mL). Voxel-based lesion symptom mapping revealed areas with high influence on higher modified Rankin Scale in regions involving the corona radiata, internal capsule, and insula. In addition, asymmetrically distributed impact patterns were found involving the right inferior temporal gyrus and left superior temporal gyrus.Conclusions-In this group of patients with stroke, characteristic lesion patterns in areas of motor control and areas involved in lateralized brain functions on early MRI were found to influence functional outcome. Our data provide a novel map of the impact of lesion localization on functional stroke outcome as measured by the modified Rankin Scale.