Early Progressive Changes in White Matter Integrity Are Associated with Stroke Recovery

Area of Science:

• Neuroimaging
• Neurology
• Radiology

Background:

• White matter integrity impacts post-stroke recovery beyond clinical assessments.
• Early detection of white matter changes can improve outcome prediction.
• Advanced MRI techniques provide insights into brain reorganization after stroke.

Purpose of the Study:

• To investigate the relationship between early white matter integrity and stroke recovery.
• To determine if microstructural white matter changes predict functional outcomes.
• To assess the predictive value of white matter integrity beyond infarct characteristics.

Main Methods:

• 42 acute ischemic stroke patients and 15 healthy controls underwent MRI scans at 24-72 hours and 3 months post-stroke.
• Diffusion tensor imaging assessed white matter integrity using fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD).
• Neurological examination and modified Rankin Scale (mRS) evaluated stroke recovery.

Main Results:

• Stroke patients exhibited decreased white matter integrity in the affected hemisphere, worsening over 3 months.
• Reduced FA in remote white matter tracts correlated with better stroke recovery.
• Mean FA of the corpus callosum and mRS at baseline predicted 53.5% of stroke recovery variance, independent of infarct volume.
• Early dynamic FA changes in the corpus callosum independently predicted stroke recovery.

Conclusions:

• Microstructural white matter integrity, assessed via advanced MRI, is a crucial predictor of stroke recovery.
• Early white matter degeneration, especially in the corpus callosum, offers prognostic information beyond infarct location and size.
• Integrating acute and dynamic white matter changes improves understanding and prediction of post-stroke reorganization and recovery.