期刊
ANNALS OF NEUROLOGY
卷 78, 期 6, 页码 860-870出版社
WILEY-BLACKWELL
DOI: 10.1002/ana.24510
关键词
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资金
- American Heart Association Scientist Development Grant [14SDG1829003]
- National Institutes of Health (NIH) [UL1 RR029882, UL1 TR000062, P20GM109040, 1R01 DC008796, R01 DC009823-01]
- Rehabilitation Research & Development Service of Department of Veterans Affairs
- Mary Crown and William Ellis Fund
- Richard and Rosalyn Slifka Family Fund
- Tom and Suzanne McManmon Family Fund
- Doris Duke Charitable Foundation
- South Carolina Clinical & Translational Research Institute/Medical University of South Carolina
Objective: The aim of this work was to investigate whether an imaging measure of corticospinal tract (CST) injury in the acute phase can predict motor outcome at 3 months in comparison to clinical assessment of initial motor impairment. Methods: A two-site prospective cohort study followed up a group of first-ever ischemic stroke patients using the Upper-Extremity Fugl-Meyer (UE-FM) Scale to measure motor impairment in the acute phase and at 3 months. A weighted CST lesion load (wCST-LL)was calculated by overlaying the patient's lesion map on magnetic resonance imaging with a probabilistic CST constructed from healthy control subjects. Regression models were fit to assess the predictive value of wCST-LL and compared with initial motor impairment. Results: Seventy-six patients (37 from cohort 1 and 39 from cohort 2) completed the study. wCST-LL as well as assessment of motor impairment (UE-FM) in the acute phase correlated with motor impairment (UE-FM) at 3 months in both cohort 1 (R-2 = 0.69 vs. R-2 = 0.67; p = 0.43) and cohort 2 (R-2 = 0.69 vs. R-2 = 0.62; p = 0.25). In the severely impaired subgroup (defined as UE-FM <= 10 at baseline), wCST-LL correlated with outcomes significantly better than clinical assessment (R-2 = 0.47 vs. R-2 = 0.11; p = 0.03). In the nonseverely impaired subgroup, stroke patients recovered approximately 70% of their maximal recovery potential. All stroke patients in both cohorts had poor motor outcomes at 3 months (defined as UE-FM <= 25) when wCST-LL was >= 7.0 cc (positive predictive value was 100%). Interpretation: wCST-LL, an imaging biomarker determined in the acute phase, can predict poststroke motor outcomes at 3 months, especially in patients with severe impairment at baseline.
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