http://stroke.ahajournals.org/content/48/8/2121?etoc=
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Abstract
Background and Purpose—Initial
clinical assessment or conventional diffusion tensor imaging parameters
alone do not reliably predict poststroke recovery of motor function.
Recently, local diffusion homogeneity (LDH) has been proposed to
represent the local coherence of water molecule diffusion and can serve
as a complementary marker for investigating white matter alterations of
the brain. We aimed to determine whether a combination of initial
clinical assessment and LDH could predict motor recovery after acute
subcortical infarction.
Methods—Standard
upper extremity Fugl-Meyer assessment and diffusion tensor imaging were
performed 1, 4, and 12 weeks after onset in 50 patients with
subcortical infarction. Proportional recovery model residuals were used
to assign patients to proportional recovery and poor recovery groups.
Tract-based spatial statistics analysis was used to compare diffusion
differences between proportional and poor recovery outcomes.
Multivariate logistic regression model was used to identify the
predictors of motor improvement within 12 weeks after stroke.
Results—The
poor recovery group had lower LDH than the proportional recovery group,
mainly in the ipsilesional corticospinal tract in the superior corona
radiate and posterior limb of internal capsule 1 week after stroke (P<0.005;
family-wise error corrected). Multivariate logistic regression analysis
indicated that both initial Fugl-Meyer assessment and LDH in the
ipsilesional corticospinal tract in the superior corona radiate and
posterior limb of internal capsule were predictors of motor improvement
within 12 weeks after stroke (G=47.22; P<0.001).
Leave-one-out cross-validation confirmed a positive predictive value of
0.818, a negative predictive value of 0.833, and an accuracy of 0.824 (P<0.00 001; permutation test).
Conclusions—These
results suggest that a combination of clinical assessment and LDH in
the ipsilesional corticospinal tract in the acute phase can accurately
predict resolution of upper limb impairment within 12 weeks after
subcortical infarction.
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