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Objective motor function assessment using diffusion tensor tractography in subacute acquired brain injury: A
Au-Jin Wang1, Choong-Hee Roh1, Myoung-Hwan Ko1,2
1Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.
Medicine
|December 30, 2025
Summary
Diffusion tensor tractography (DTT) metrics, including corticospinal tract (CST) fiber number and fractional anisotropy ratios, objectively indicate motor function after brain injury. These DTT measures offer valuable thresholds for rehabilitation planning.
Area of Science:
- Neuroscience
- Medical Imaging
- Rehabilitation Medicine
Background:
- Corticospinal tract (CST) integrity is crucial for motor recovery post-brain injury.
- Diffusion tensor tractography (DTT) quantifies CST microstructural integrity, but clinical thresholds for predicting motor function are lacking.
Purpose of the Study:
- To evaluate DTT-derived CST fiber number (FN) and fractional anisotropy (FA) ratios (affected/unaffected) as objective indicators of motor function in subacute focal brain injury.
- To determine optimal cutoff values for these DTT metrics.
Main Methods:
- Retrospective analysis of 70 patients with subacute unilateral hemiparesis from various focal brain injuries.
- Assessment of motor function using the Medical Research Council (MRC) scale, hand function tests (HFTs), and Modified Barthel Index (MBI).
- Calculation of CST FN and FA ratios (affected/unaffected) and application of receiver operating characteristic (ROC) analyses to identify optimal cutoff values.
Main Results:
- Significantly reduced CST FN and FA values were observed on the affected side in all patients (P < .001).
- Higher CST FN and FA ratios correlated with better neurophysiologic (motor-evoked potential amplitudes) and functional outcomes (MRC grade, HFT scores, MBI).
- ROC analysis identified clinically applicable cutoff values for CST ratios that increased with task difficulty.
Conclusions:
- DTT-derived CST FN and FA ratios provide quantitative, objective indicators of motor function in subacute focal brain injury.
- These tract-based metrics can aid clinical decision-making and rehabilitation planning by offering reproducible thresholds linked to functional performance.
