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Corticospinal tract diffusion abnormalities early after stroke predict motor outcome.

Benjamin N Groisser1, William A Copen2, Aneesh B Singhal3

  • 1MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

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Summary

Early corticospinal tract (CST) injury, measured by diffusion tensor imaging (DTI), strongly predicts upper limb motor recovery in stroke patients. Acute axial diffusivity (AD) loss is a key indicator of long-term outcomes.

Keywords:
corticospinal tract (CST)dexteritydiffusion tensor imaging (DTI)motor impairmentmotor recoverypredictionprognosisstrengthstrokeupper limb

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Area of Science:

  • Neuroscience
  • Neurology
  • Radiology

Background:

  • Predicting long-term motor function in acute stroke patients with severe motor impairment is challenging.
  • Understanding the early indicators of motor recovery is crucial for effective patient management and rehabilitation.

Purpose of the Study:

  • To assess the prognostic value of corticospinal tract (CST) injury on upper limb motor outcomes.
  • To compare the predictive power of CST injury with motor impairment level and lesion volume.

Main Methods:

  • Diffusion tensor imaging (DTI) was used to assess CST integrity in 10 acute stroke patients.
  • Tractography and a CST atlas quantified CST injury, measuring axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA).
  • Measurements were taken at acute, subacute, and chronic post-stroke time points.

Main Results:

  • Acute loss in CST axial diffusivity (AD) showed the strongest correlation with subacute and chronic upper limb strength and dexterity.
  • This correlation remained significant even after accounting for initial motor impairment or lesion volume.
  • Subacute fractional anisotropy (FA) loss correlated with chronic dexterity, while subacute strength predicted chronic strength.

Conclusions:

  • Early CST injury, particularly acute AD loss and subacute FA loss, are significant predictors of upper limb motor function recovery in stroke survivors.
  • Diffusion tensor imaging (DTI)-based CST injury assessment offers valuable insights for healthcare planning and clinical trial design in acute stroke.