Motor outcome according to diffusion tensor tractography findings in the early stage of intracerebral hemorrhage

doi:10.1016/j.neulet.2007.04.052

Neuroscience Letters

Volume 421, Issue 2, 27 June 2007, Pages 142-146

https://doi.org/10.1016/j.neulet.2007.04.052 Get rights and content

Abstract

We tried to investigate the motor outcome according to diffusion tensor tractography (DTT) findings for the corticospinal tract (CST) in the early stage for hemiparetic patients with intracerebral hemorrhage (ICH). Forty patients with severe paralysis of the affected side were enrolled. DTT was obtained in the early stage of the stroke (7–30 days) and was classified into four groups: type A, the CST originating from primary motor cortex was preserved around the hematoma; type B, the CST was similar to type A except the fiber originated from the adjacent areas to the primary motor cortex; type C, the CST was interrupted at or around the hematoma; and type D, the CST did not reach the hematoma due to degeneration (Fig. 1). Six months after onset, motor function was measured and the statistical influence of the DTT type was tested. Initially, none of the motor function scales of the affected side differed among the four DTT types. Six months after the onset of ICH, motor functions of the same side were significantly different according to DTT type (p < 0.05). All motor scales were highest in the DTT type A group, and were lowest in the DTT type D group (p < 0.0003). The early DTT findings for CST may be used to predict the motor outcome of the affected extremities in hemiparetic patients with ICH.

Section snippets

Acknowledgement

This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korea government (MOST) (No. M10642120004-06N4212-00410).

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Although the putamen is the most common area of spontaneous intracerebral hemorrhage, previous reports about the effects of surgery are limited. We sometimes experience a poor prognosis in patients in whom there is no damage to the internal capsule, but with injury in the long insular artery (LIA) region. The purpose of this study was to confirm the relationship between LIA damage and patient prognosis following surgery for putaminal hemorrhage.
We retrospectively collected data of 287 surgical cases who presented with putaminal hemorrhage between January 2004 and March 2022. Among them, we chose patients without initial damage to the posterior limb of the internal capsule, and divided these patients into two groups, those without (Group A) and with (Group B) final damage in the LIA region. We compared positivity rates of final manual muscle test (MMT) scores ≥ 3 and related factors.
Sixty-three of the 287 patients were included in this study. Of them, 11 cases in Group A were positive for MMT scores ≥ 3 (68.8%) and 9 cases (19.1%) in Group B had MMT scores ≥ 3 seven days after surgery. Group A thus had a significantly higher rate of MMT scores ≥ 3 than group B (p = 0.00).
In patients without initial damage to the internal capsule, LIA injury might be a key sign for predicting the functional prognosis of putaminal hemorrhage.
Aunque el putamen es la zona más común de la hemorragia intracerebral espontánea, los informes previos sobre los efectos de la cirugía son limitados. En ocasiones se observa un mal pronóstico en los pacientes en los que no hay daño en la cápsula interna, pero sí en la región de la arteria insular larga (AIL). El propósito de este estudio fue confirmar la relación entre el daño de la AIL y el pronóstico de los pacientes tras la cirugía de la hemorragia putaminal.
Se recogieron retrospectivamente los datos de 287 casos quirúrgicos que se presentaron con hemorragia putaminal entre enero de 2004 y marzo de 2022. Entre ellos, elegimos a los pacientes sin daño inicial en la extremidad posterior de la cápsula interna, y dividimos a estos pacientes en 2 grupos, los que no tenían (grupo A) y los que tenían (grupo B) daño final en la región AIL. Se compararon las tasas de positividad de las puntuaciones finales de la prueba muscular manual (TMM) ≥ 3 y los factores relacionados.
Sesenta y tres de los 287 pacientes fueron incluidos en este estudio. De ellos, 11 casos del grupo A tuvieron puntuaciones de MMT ≥ 3 positivas (68,8%) y 9 casos (19,1%) del grupo B tuvieron puntuaciones de MMT ≥ 3, 7 días después de la cirugía. Así pues, el grupo A tuvo una tasa significativamente mayor de puntuaciones MMT ≥ 3 que el grupo B (p = 0,00).
En los pacientes sin daño inicial en la cápsula interna, la lesión del AIL podría ser un signo clave para predecir el pronóstico funcional de la hemorragia putaminal.
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The critical role of different adjuncts in improving the neurological outcome in intrinsic brain lesions affecting eloquent areas is demonstrated by their more diffuse utilization. Neurosurgeons often rely on preoperative and intraoperative diffusion tensor imaging tractography to improve the operative strategy and prognosis. We aimed to identify and validate a diffusion tensor imaging–based classification considering the relationship between the brain lesion and the corticospinal tract to predict a >50% reduction of motor evoked potentials (MEPs) during surgical excision of lesions involving the motor pathways.
We included patients consecutively enrolled at our institution between April 2020 and September 2022 with 3 patterns of increasing complexity according to the relationship between the lesion and the corticospinal tract as identified on preoperative diffusion tensor imaging. Outcome measures were >50% reduction in intraoperative MEPs and neurological outcome defined as unchanged, improved, or worsened.
The study included 83 patients. A statistically significant linear trend between higher rates of reduction of MEPs and higher classification grades was observed (P = 0.001), with sensitivity 0.60, specificity 0.88, accuracy 0.83, and area under the curve 0.75. Higher grades were associated with worse neurological outcomes (P = 0.02).
The classification proved reliable in anticipating reduction in intraoperative MEPs and in predicting neurological outcome. Using this classification in patients undergoing surgery for lesions involving the motor pathways could help in counseling the patient, surgical planning, enhancing teamwork of operating room personnel, and improving the patient's prognosis.
Current applications of diffusion tensor tractography analysis of corticospinal tracts for prognostication of motor outcomes or optimization of neurosurgical intervention in hypertensive intracranial hemorrhage
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Intracranial hemorrhage (ICH) causes often devastating brain injury. Predicting long-term motor prognosis and identifying neurosurgical candidates in cases of ICH has been an imprecise practice. Diffusion tensor tractography (DTT) is an imaging modality that may aid in this challenge. This literature review aimed to investigate DTT applications in patients with spontaneous ICH for either motor function prognosis or surgical intervention.
A PubMed and Ovid literature review was performed to select and evaluate studies utilizing DTT for motor prognostication or analysis/optimization of surgical outcomes in patients with spontaneous hypertensive ICH. Studies investigating ICH due to suspected vascular anomalies were excluded.
Forty-two studies met criteria. Six studies addressed surgical application. Surgery was not associated with increased mortality but was associated with decreased hematoma volume and CST compression and improved motor outcomes. Prognostic studies demonstrated that DTT correlates with motor function at multiple timepoints.
DTT is a relatively new imaging technique that may help predict prognosis of patients’ motor function after spontaneous ICH. Additionally, it could possibly serve as an adjunct for determining which patients would benefit from surgical decompression or even help guide surgical approach to hematomas that displace the CST.
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Different diffusion tensor imaging (DTI) has been used to estimate corticospinal tract (CST) structure in the context of stroke rehabilitation research. However, there is no gold standard for the estimate of CST structure in chronic stroke survivors. This study aims to determine the most accurate DTI-derived CST estimate that is associated with a clinical motor outcome measure.
We obtained imaging and behavioral data from a phase-I stroke rehabilitation clinical trial. We included thirty-seven chronic stroke survivors with mildtomoderate motor impairment. Imaging data were processed using BrainSuite16a software. We calculated mean FA for each of 7 different ROIs/VOIs that include manually drawn 2-D ROIs and 3-D VOIs of CST from individual tractography or standard atlas. We compared ipsi- and contralesional CST FA for each method. Partial correlation was conducted between each CST FA asymmetry index and a time-based motor outcome measure, controlling for age and chronicity.
Ipsilesional CST FA was significantly lower than contralesional CST FA for each of the 7 methods Only CST FA asymmetry from the 3-D individual CST tractography showed a significant correlation with the primary motor outcome (r = 0.46, p = .005), while CST FA from the other six methods did not.
Compared to the six other methods, CST FA asymmetry from 3-D individual tractography is the most accurate estimate of CST structure in this cohort of stroke survivors.
We recommend this method for future research seeking to understand brain-behavior mechanisms of motor recovery in chronic stroke survivors.
Significant Injury of the Mammillothalamic Tract without Injury of the Corticospinal Tract After Aneurysmal Subarachnoid Hemorrhage: A Retrospective Diffusion Tensor Imaging Study
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Citation Excerpt :
However, the exact pathophysiologic mechanisms have not been clearly illustrated so far.1,5,7 DTI is a newly introduced technique that evaluates the integrity of the white matter tracts that cannot be assessed by conventional magnetic resonance imaging by virtue of its capability to visualize water diffusion characteristics.1,4,7,9-14 In addition, it can detect subtle but clinically meaningful changes after SAH.1-3,7,11
Little is known about the pathophysiologic mechanisms of white matter injury after aneurysmal subarachnoid hemorrhage (aSAH). The purpose of this study is to investigate whether the mammillothalamic tract (MTT) or corticospinal tract (CST) is more affected by aSAH in the same patients with good outcome (Grade 5 on Glasgow Outcome Scale at 3 months) using diffusion tensor imaging (DTI).
Between June 2013 and September 2016, 21 patients with aSAH with good outcome and 21 sex- and age-matched normal healthy control participants were recruited. DTI was obtained at 8.92 ± 2.4 weeks after onset. Moreover, reconstruction of the CST and the MTT was completed with DTI-studio software. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured. In addition, the motricity index and Mini-Mental State Examination scores were obtained.
There was no statistically significant difference detected in the ADC and FA values of the CST between the patient and control groups (P > 0.05). On the contrary, there was a statistically significant difference in ADC and FA values of the MTT between the patient and control groups (P < 0.05). In addition, in the patient group, no correlation (P > 0.05) was observed between motricity index scores and DTI parameters (ADC and FA), whereas the Mini-Mental State Examination showed a positive correlation with FA (r = 0.591, P = 0.029) without correlation to ADC (r = 0.142, P = 0.628).
Patients with good outcomes (Grade 5 on Glasgow Outcome Scale at 3 months) after aSAH appeared to suffer an injury of the MTT without an associated injury of the CST compared with the control group. This injury showed a correlation with cognitive dysfunction.
Utility of Fractional Anisotropy in Cerebral Peduncle for Stroke Outcome Prediction: Comparison of Hemorrhagic and Ischemic Strokes
2018, Journal of Stroke and Cerebrovascular Diseases
Diffusion-tensor fractional anisotropy (FA) has been used for predicting stroke outcome. However, most previous studies focused on patients with either hemorrhagic or ischemic stroke. The aim of this study was to assess the correlation between FA and outcome for patients with hemorrhagic stroke and those with ischemic stroke, and then compare their correlation patterns.
This study sampled 40 hemorrhagic and 40 ischemic stroke patients from our previously published reports. Diffusion-tensor images were obtained on days 14-21, and FA images were generated, after which the ratio of FA within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated. Outcome was assessed using Brunnstrom stage (BRS), motor component of the functional independence measure (FIM-motor), and total length of hospital stay (LOS) at discharge from our affiliated rehabilitation hospital. The data were then compared between the hemorrhage and the infarct groups. Correlation analyses between rFA and outcome assessments were performed separately for both groups and then were compared between the groups.
The hemorrhage group exhibited significantly more severe BRS, longer LOS, and lower rFA than the infarct group. The correlations between rFA and outcome measures were all statistically significant for both the hemorrhage and the infarct groups. The correlation patterns for BRS and LOS were very similar between the hemorrhage and the infarct groups. However, such similarity was not evident for FIM-motor.
FA in the cerebral peduncles may be used to predict extremity functions and LOS for both types of stroke.

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View full text

Motor outcome according to diffusion tensor tractography findings in the early stage of intracerebral hemorrhage

Abstract

Section snippets

Acknowledgement

J. Magn. Reson. B

Neuroimage

Neuroimage

Thompson From diffusion tractography to quantitative white matter tract measures: a reproducibility study

Neuroimage

Performance-based gait tests for acute stroke patients

Am. J. Phys. Med. Rehabil.

Motor evaluation in vascular hemiplegia

Eur. Neurol.

Prognostic value of motor evoked potential obtained by transcranial magnetic brain stimulation in motor function recovery in patients with acute ischemic stroke

Stroke

Cortical reorganization in patients with subcortical hemiparesis: neural mechanisms of functional recovery and prognostic implication

J. Neurosurg.

MR diffusion tensor imaging of white matter tract disruption in stroke at 3 T

Br. J. Radiol.

Cortical mechanisms of recovery of function after stroke

Neurorehabilitaion

Longitudinal study of central motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months

Brain

Diffusion anisotropy of the internal capsule and the corona radiata in association with stroke and tumors as measured by diffusion-weighted MR imaging

Am. J. Neuroradiol.

Diffusion anisotrophy in the early stages of stroke can predict motor outcome

Restor. Neurol. Neurosci.