Corticospinal tract lesion load: An imaging biomarker for stroke motor outcomes

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...

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Published in	Annals of neurology Vol. 78; no. 6; pp. 860 - 870
Main Authors	Feng, Wuwei, Wang, Jasmine, Chhatbar, Pratik Y., Doughty, Christopher, Landsittel, Douglas, Lioutas, Vasileios-Arsenios, Kautz, Steven A., Schlaug, Gottfried
Format	Journal Article
Language	English
Published	United States Blackwell Publishing Ltd 01.12.2015 Wiley Subscription Services, Inc
Subjects	Adult Aged Biomarkers Brain Ischemia - pathology Brain Ischemia - physiopathology Female Follow-Up Studies Humans Magnetic Resonance Imaging - methods Male Middle Aged Outcome Assessment (Health Care) - methods Prognosis Pyramidal Tracts - pathology Pyramidal Tracts - physiopathology Recovery of Function - physiology Severity of Illness Index Stroke Stroke - diagnosis Stroke - pathology Stroke - physiopathology Time Factors Upper Extremity - physiopathology
Online Access	Get full text
ISSN	0364-5134 1531-8249 1531-8249
DOI	10.1002/ana.24510

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Abstract	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 (R2 = 0.69 vs. R2 = 0.67; p = 0.43) and cohort 2 (R2 = 0.69 vs. R2 = 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 (R2 = 0.47 vs. R2 = 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. Ann Neurol 2015;78:860–870
AbstractList	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 (R2 = 0.69 vs. R2 = 0.67; p = 0.43) and cohort 2 (R2 = 0.69 vs. R2 = 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 (R2 = 0.47 vs. R2 = 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. Ann Neurol 2015;78:860–870 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 super(2)=0.69 vs. R super(2)=0.67; p=0.43) and cohort 2 (R super(2)=0.69 vs. R super(2)=0.62; p=0.25). In the severely impaired subgroup (defined as UE-FM less than or equal to 10 at baseline), wCST-LL correlated with outcomes significantly better than clinical assessment (R super(2)=0.47 vs. R super(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 less than or equal to 25) when wCST-LL was greater than or equal to 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. Ann Neurol 2015; 78:860-870 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. 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. 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%). 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. 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 (R2=0.69 vs. R2=0.67; p=0.43) and cohort 2 (R2=0.69 vs. R2=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 (R2=0.47 vs. R2=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. Ann Neurol 2015;78:860-870 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.OBJECTIVEThe 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.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.METHODSA 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.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%).RESULTSSeventy-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%).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.INTERPRETATIONwCST-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.
Author	Feng, Wuwei Doughty, Christopher Wang, Jasmine Kautz, Steven A. Schlaug, Gottfried Chhatbar, Pratik Y. Lioutas, Vasileios-Arsenios Landsittel, Douglas
Author_xml	– sequence: 1 givenname: Wuwei surname: Feng fullname: Feng, Wuwei organization: Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, SC – sequence: 2 givenname: Jasmine surname: Wang fullname: Wang, Jasmine organization: Neuroimaging & Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston – sequence: 3 givenname: Pratik Y. surname: Chhatbar fullname: Chhatbar, Pratik Y. organization: Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, SC, Charleston – sequence: 4 givenname: Christopher surname: Doughty fullname: Doughty, Christopher organization: Neuroimaging & Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston – sequence: 5 givenname: Douglas surname: Landsittel fullname: Landsittel, Douglas organization: Section on Biomarkers and Prediction Modeling, Department of Medicine, University of Pittsburgh, PA, Pittsburgh – sequence: 6 givenname: Vasileios-Arsenios surname: Lioutas fullname: Lioutas, Vasileios-Arsenios organization: Neuroimaging & Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston – sequence: 7 givenname: Steven A. surname: Kautz fullname: Kautz, Steven A. organization: Ralph H. Johnson VA Medical Center, Charleston, SC – sequence: 8 givenname: Gottfried surname: Schlaug fullname: Schlaug, Gottfried email: gschlaug@bidmc.harvard.edu organization: Neuroimaging & Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26289123$$D View this record in MEDLINE/PubMed
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References_xml	– reference: Bagg S, Pombo AP, Hopman W. Effect of age on functional outcomes after stroke rehabilitation. Stroke 2002;33:179-185. – reference: Cooke EV, Mares K, Clark A, Tallis RC, Pomeroy VM. The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis. BMC Med 2010;8:60. – reference: Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G; EPOS Investigators. Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: Early prediction of functional outcome after stroke: the EPOS cohort study. Stroke 2010;41:745-750. – reference: Smania N, Paolucci S, Tinazzi M, et al. Active finger extension: a simple movement predicting recovery of arm function in patients with acute stroke. Stroke 2007;38:1088-1090. – reference: Stinear CM, Barber PA, Smale PR, et al. 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Snippet	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... 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... 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...
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SubjectTerms	Adult Aged Biomarkers Brain Ischemia - pathology Brain Ischemia - physiopathology Female Follow-Up Studies Humans Magnetic Resonance Imaging - methods Male Middle Aged Outcome Assessment (Health Care) - methods Prognosis Pyramidal Tracts - pathology Pyramidal Tracts - physiopathology Recovery of Function - physiology Severity of Illness Index Stroke Stroke - diagnosis Stroke - pathology Stroke - physiopathology Time Factors Upper Extremity - physiopathology
Title	Corticospinal tract lesion load: An imaging biomarker for stroke motor outcomes
URI	https://api.istex.fr/ark:/67375/WNG-3SDZGLT3-0/fulltext.pdf https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fana.24510 https://www.ncbi.nlm.nih.gov/pubmed/26289123 https://www.proquest.com/docview/1757051016 https://www.proquest.com/docview/1760883866 https://www.proquest.com/docview/1776662869
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