MR tractography for the evaluation of functional recovery from lenticulostriate infarcts

Objective: To evaluate the anatomic and clinical relationship between the lenticulostriate artery (LSA) territory and the corticospinal tract (CST) in patients with acute infarcts in this territory using MR tractography. Methods: Thirteen consecutive patients who presented with acute infarcts in the LSA territory and who also had undergone an MRI study within 3 days after symptom onset were studied. Visualization of the CST was achieved by postprocessing the acquired diffusion tensor imaging data. To classify lesion location, the LSA territory was divided into four subsegments, the boundaries of which were drawn by axial and coronal planes crossing through the foramen of Monro. Infarct volume and extent of CST involvement were measured and compared with neurologic findings. Results: All of the infarcts were located in the posterior segment. All of the depicted CSTs crossed the LSA territory only at the posterosuperior quadrant. The extent of CST involvement within the infarcts was correlated with the severity of the patient's motor deficit (p < 0.01) and with the clinical outcome (p < 0.05). Conclusions: The corticospinal tracts (CSTs) crossed the lenticulostriate artery territory exclusively at the posterosuperior quadrant, and the degree of CST involvement within the infarcts was directly related to stroke severity and functional recovery.