Detection and Predictive Value of Fractional Anisotropy Changes of the Corticospinal Tract in the Acute Phase of a Stroke

Background and Purpose-A decrease in fractional anisotropy (FA) of the ipsilesional corticospinal tract (CST) distal to stroke lesions in the subacute (eg, 30 days) and chronic phase has been correlated with poor motor outcomes, but it is unclear whether FA values obtained within the acute stroke phase (here defined as 80 hours after onset) can predict later outcome. Methods-Fifty-eight patients underwent an assessment of motor impairment in the acute phase and at 3 months using the upper extremity Fugl-Meyer assessment. FA values, obtained within 80 hours after stroke onset, were determined in 2 regions of interest: cerebral peduncle and a stretch of the CST caudal to each stroke lesion (nearest-5-slices). Results-The FA laterality index for the cerebral peduncle-regions of interest was a poor predictor of 3-month outcome (R-2=0.044; P=0.137), whereas the slope over the FA laterality index of the nearest-5-slices showed a relatively weak but significant prediction (R-2=0.11; P=0.022) with the affected side having lower FA values. Initial upper extremity Fugl-eyer (R-2=0.69; P<0.001) and the weighted CST lesion load (R-2=0.71; P<0.001) were strong predictors of 3-month outcome. In multivariate analyses, controlling for initial upper extremity Fugl-Meyer, weighted CST lesion load, and days-f-therapy, neither the FA laterality index of the cerebral peduncle nor the slope over the FA laterality index of the nearest-5-slices significantly contributed to the prediction of 86% of the variance in the upper extremity Fugl-Meyer at 3 months. Conclusions-FA reductions of the CST can be detected near the ischemic lesion in the acute stroke phase, but offer minimal predictive value to motor outcomes at 3 months.