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Optimizing the Approach to Calculating CST Lesion Load in Ischemic Stroke Patients for Understanding Motor Outcomes.
Brady J Williamson1, Tyler Behymer1, Anne Schwarz2,3
1University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH, USA.
Neurorehabilitation and Neural Repair
|March 2, 2026
Summary
The maximum weighted lesion load (Max-WLL) best predicts motor and functional recovery after stroke. Using an age-appropriate corticospinal tract template improves accuracy for stroke patients.
Area of Science:
- Neuroscience
- Neurology
- Biomarker Research
Background:
- Corticospinal tract lesion load (CST-LL) is a key biomarker for stroke motor outcomes.
- Current methods for calculating CST-LL lack standardization, hindering research comparability.
Purpose of the Study:
- To identify the optimal method for calculating CST-LL.
- To validate the chosen CST-LL metric and template in independent stroke cohorts.
Main Methods:
- Cross-sectional study of two large ischemic stroke cohorts (n=221 and n=125).
- Comparison of four lesion load metrics across three CST templates.
- Validation of findings using motor (FMUE) and functional (BI) outcome measures.
Main Results:
- Maximum weighted cross-sectional overlap (Max-WLL) best explained variance in motor and functional outcomes (REV=58.9% for FMUE, 60% for BI).
- An age-appropriate normative CST template improved outcome prediction.
- Findings were replicated in an independent validation cohort (REV=47.6% for FMUE).
Conclusions:
- Max-WLL accurately quantifies CST injury related to post-stroke motor and functional outcomes.
- The use of age-appropriate CST templates is crucial for stroke research.
- This validated method optimizes future research on CST injury after stroke.
