(Stroke. 2000;31:672.)
© 2000 American Heart Association, Inc.
Original Contributions |
Relating MRI Changes to Motor Deficit After Ischemic Stroke by Segmentation of Functional Motor Pathways
From the Oxford Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital (R.P., S.T.P., S.S., D.F., P.M.M.), and the MRC Biochemical and Clinical Magnetic Resonance Unit, Department of Biochemistry, and the John Radcliffe Hospital (S.T.P., A.M.B., P.S.), Oxford, UK. Drs Pineiro and Pendlebury contributed equally to the article.
Correspondence to Dr S.T. Pendlebury, Oxford Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, Oxford, OX3 9DU, UK. E-mail stpendle{at}bioch.ox.ac.uk
Background and Purpose—Infarct size on T2-weighted MRI correlates only modestly with outcome, particularly for small strokes. This may be largely because of differences in the locations of infarcts and consequently in the functional pathways that are damaged. To test this hypothesis quantitatively, we developed a "mask" of the corticospinal pathway to determine whether the extent of stroke intersection with the pathway would be more closely related to clinical motor deficit and axonal injury in the descending motor pathways than total stroke lesion volume.
Methods—Eighteen patients were studied 
1 month after first
ischemic stroke that caused a motor deficit by use of brain
T2-weighted imaging, MR spectroscopic (MRS) measurements of the
neuronal marker compound N-acetyl aspartate in the
posterior limb of the internal capsule, and motor impairment and
disability measures. A corticospinal mask based on neuroanatomic
landmarks was generated from a subset of the MRI data. The maximum
proportion of the cross-sectional area of this mask occupied by stroke
was determined for each patient after all brain images were transformed
into a common stereotaxic brain space.
Results—There was a significant linear relationship between the maximum proportional cross-sectional area of the corticospinal mask occupied by stroke and motor deficit (r2=0.82, P<0.001), whereas the relationship between the total stroke volume and motor deficit was better described by a cubic curve (r2=0.76, P<0.001). Inspection of the data plots showed that the total stroke volume discriminated poorly between smaller strokes with regard to the extent of associated motor deficit, whereas the maximum proportion of the mask cross-sectional area occupied by stroke appeared to be a more discriminatory marker of motor deficit and also N-acetyl aspartate reduction.
Conclusions—Segmentation of functional motor pathways on MRI allows estimation of the extent of damage specifically to that pathway by the stroke lesion. The extent of stroke intersection with the motor pathways was more linearly related to the magnitude of motor deficit than total lesion volume and appeared to be a better discriminator between small strokes with regard to motor deficit. This emphasizes the importance of the anatomic relationship of the infarct to local structures in determining functional impairment. Prospective studies are necessary to assess whether this approach would allow improved early estimation of prognosis after stroke.
Key Words: brain • cerebrovascular disorders • magnetic resonance imaging • outcome • spectroscopy, nuclear magnetic resonance
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