Josep Puig Alcantara MD, Presenter: Nothing to Disclose

Gerard Blasco RT, Abstract Co-Author: Nothing to Disclose

Josep Daunis-Estadella, Abstract Co-Author: Nothing to Disclose

Sebastian Remollo, Abstract Co-Author: Nothing to Disclose

Joaquin Serena MD, PhD, Abstract Co-Author: Nothing to Disclose

Salvador Pedraza MD, Abstract Co-Author: Research Consultant, H. Lundbeck A/S

The objectives of this study were to investigate whether lesion location at diffusion tensor tractography (DTT) is predictive of motor recovery after acute stroke and to determine whether this information improves the predictive accuracy of the clinical scores. DTT should be capable of detecting critical regions of the motor pathways in the acute setting.

We evaluated 60 patients (38 men; mean age,68±13years) with middle cerebral artery (MCA) stroke within 12 hours of onset. We used DTT to evaluate corticospinal tract (CST) involvement at the level of the motor cortex, premotor cortex, centrum semiovale, corona radiate, and posterior limb of the internal capsule (PLIC) as well as combinations of these structures at admission, at day 3, and at day 30. The severity of limb weakness was assessed using the motor subindex of the National Institute of Health Stroke Scale (5a,5b,6a,6b). Fractional anisotropy values were measured in the pons of the affected and unaffected sides of the CST.

Acute damage to the PLIC was the only variable associated with poor motor outcome, axonal damage, and clinical severity at admission (P<.001). There was no significant correlation between acute infarct volume and motor outcome at day 90 (P=0.176,r=0.485). The sensitivity, specificity, and positive and negative predictive values of acute CST involvement at the level of the PLIC for motor outcome at day 90 were 73.7%, 100%, 100%, and 89.1%, respectively. In the multiple regression analysis, DTT predicted motor outcome at day 90 better than the clinical scores in acute stroke (R2=75.50,F=80.09,P<.001).

DTT might be useful for stroke mapping techniques to predict motor outcome in the acute setting. Acute CST involvement at the level of the PLIC is a significant early imaging predictor of unfavorable motor recovery.

Early prediction of motor outcome is of interest in stroke management. To our knowledge, no prospective, controlled studies have assessed the predictive ability of DTT for motor recovery after stroke.

Puig Alcantara, J, Blasco, G, Daunis-Estadella, J, Remollo, S, Serena, J, Pedraza, S, Acute Damage to the Posterior Limb of the Internal Capsule Using Diffusion Tensor Tractography as an Early Predictor of Motor Outcome after Stroke.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008875.html