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Comparison of post-stroke white matter assessment using disconnectome-symptom mapping versus quantitative diffusion
Martin Domin1, Sook-Lei Liew2, Brenton Hordacre3
1Functional Imaging Unit, Diagnostic and Neuroradiology, University Hospital Greifswald, Greifswald, Germany.
Neuroimage
|June 29, 2025
Summary
Disconnection-symptom mapping (DSM) shows promise for assessing white matter damage after stroke, but a significant portion of cases lack lesion-tract overlap, potentially inflating results. Further validation is needed for reliable clinical application.
Area of Science:
- Neuroscience
- Neurology
- Medical Imaging
Background:
- Indirect structural disconnection-symptom mapping (DSM) is used to assess white matter impairment post-stroke.
- This method, while common, lacks comprehensive validation.
- Multi-directional diffusion (MDDW) imaging is typically required for individual assessments.
Purpose of the Study:
- To validate the indirect structural disconnection-symptom mapping (DSM) method.
- To compare DSM with the fractional anisotropy method (FAM) for assessing white matter integrity.
- To investigate the association between white matter integrity and upper limb impairment after stroke.
Main Methods:
- A multicenter dataset of 166 chronic stroke survivors with upper limb impairment was analyzed.
- White matter integrity was quantified using fractional anisotropy (FAM) and disconnection-symptom mapping (DSM).
- Tracts analyzed included the corticospinal tract (CST), superior lateral fasciculus (SLF), and corpus callosum (CC).
Main Results:
- Both FAM and DSM demonstrated comparable associations between corticospinal tract (CST) integrity and Fugl-Meyer upper extremity score (FMUE).
- DSM showed a strong association with FMUE, partly due to a high number of participants (57/166 for CST) with no lesion-tract overlap.
- FAM allowed analysis of participants with no lesion-tract overlap, unlike DSM.
Conclusions:
- While DSM shows potential for quantifying white matter integrity in stroke patients, its validity is questionable.
- A significant proportion of cases exhibited no lesion-tract overlap, leading to potentially artificial associations with clinical outcomes.
- Further validation is crucial before widespread clinical adoption of DSM.
