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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
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The association between lesion location and functional outcome after ischemic stroke
Nawaf Yassi1, Leonid Churilov2, Bruce C V Campbell1
1Department of Neurology, Melbourne Brain Centre @ Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia.
Summary
Infarct location significantly impacts stroke recovery. Specific brain regions, including the uncinate fasciculus and parietal lobe, are key predictors of poor functional outcomes after ischemic stroke.
Area of Science:
- Neurology
- Neuroscience
- Radiology
Background:
- Infarct location critically affects patient outcomes in ischemic stroke.
- Studying infarct location's independent role, separate from lesion volume, is challenging.
- This study analyzes the impact of infarct location on functional outcomes using pooled data.
Purpose of the Study:
- To investigate the effect of infarct location on three-month functional outcomes in ischemic stroke patients.
- To identify specific brain regions associated with nonfavorable outcomes.
- To differentiate the prognostic importance of infarct locations between hemispheres.
Main Methods:
- Retrospective analysis of pooled EPITHET and DEFUSE studies.
- Manual segmentation of post-treatment MRI diffusion lesions.
- Utilized a novel composite brain atlas for regional infarction percentage calculation.
- Classification and Regression Tree (CART) analysis to identify key regions linked to poor outcomes (modified Rankin score > 1 at 90 days).
Main Results:
- 152 patients included; 82 with left hemisphere infarcts.
- Left hemisphere: Uncinate fasciculus, precuneus, and angular gyrus infarction were strongest predictors of nonfavorable outcome.
- Right hemisphere: Parietal lobe and putamen infarction were strongest predictors of nonfavorable outcome.
Conclusions:
- Infarct location, analyzed via CART, reveals distinct regional characteristics linked to poor stroke outcomes.
- Prognostically significant areas include limbic, default-mode, and language regions in the left hemisphere.
- Visuospatial and motor regions in the right hemisphere are also critical determinants of outcome.
