Josep Puig Alcantara MD, Presenter: Nothing to Disclose

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

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

Guadalupe Soria, Abstract Co-Author: Nothing to Disclose

Alberto Prats-Galino, Abstract Co-Author: Nothing to Disclose

Mar Castellanos MD, PhD, Abstract Co-Author: Nothing to Disclose

Ferran Prados, Abstract Co-Author: Nothing to Disclose

Imma Boada, Abstract Co-Author: Nothing to Disclose

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

Over 50% of acute ischemic stroke (AIS) patients have motor deficit. We aim to determine the accuracy of variables in predicting long-term motor outcome after AIS and whether the structural integrity of the corticospinal tract (CST) at diffusion tensor imaging (DTI) correlates with motor outcome.

Consecutive patients with anterior circulation AIS underwent multimodal MRI including DTI ≤12 hours, 3 days, and 30 days after symptom onset. Clinical and demographic data were recorded. Imaging analysis included assessment of infarct volume, level of vascular occlusion, location of CST damage on diffusion tensor tractography (motor and premotor cortex, centrum semiovale, corona radiata, and posterior limb of internal capsule (PLIC)), fractional anisotropy ratio (rFA) between affected and unaffected sides of the CST, recanalization after IV rt-PA (TIMI score 0-3), and hemorrhagic transformation. Motor outcomes obtained at 2-year follow-up were classified as good (Motricity Index Score (MI) 100), intermediate (MI 99-55), or poor (MI 49-0).

We evaluated 70 patients (28 women; age 72±15 years). Median NIHSS score was 12 (IQR 6-18). At admission, 55 (78.6%) had some motor deficit and CST damage was seen in 76.7%. Infarct volume at day 30 was 11.2 mL (IQR 7.2-164). Motor outcome was classified as intermediate in 18 (25.75%) patients and poor in 13 (18.6%). Lower rFA values correlated with motor deficit at day 30 (p<0.001;r = -0.801). Independent predictors of long-term motor outcome were rFA at day 30, infarct volume at day 3, motor deficit at day 30, and PLIC damage on admission. rFA at day 30 was the best predictor of long-term motor outcome (OR,35.45; 95%CI,32.23-39.87; p<0.001). The best rFA cutoff for discriminating good vs intermediate and intermediate vs poor outcome at 2 years were 0.978 and 0.685, respectively (AUC=0.99, p<0.001).

rFA is an independent predictor of long-term motor outcome after AIS. Imaging follow-up 30 days after AIS is useful and rFA can be a surrogate marker for motor deficit in clinical trials.

Imaging biomarkers of stroke damage can help predict motor outcome after AIS.

Puig Alcantara, J, Blasco, G, Daunis-i-Estadella, J, Soria, G, Prats-Galino, A, Castellanos, M, Prados, F, Boada, I, Pedraza, S, Quantitative Diffusion Tensor Imaging Predicts Long-term Motor Outcome after Acute Ischemic Stroke.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013072.html