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The potential of the adult brain to reorganize after ischemic injury is critical for functional recovery and provides a significant target for therapeutic strategies to promote brain repair. Despite the accumulating evidence of brain plasticity, the interaction and significance of morphological and physiological modifications in post-stroke brain tissue remain mostly unclear. Neuroimaging techniques such as functional MRI (fMRI) and diffusion tensor imaging (DTI) enable in vivo assessment of the spatial and temporal pattern of functional and structural changes inside and outside ischemic lesion areas. This can contribute to the elucidation of critical aspects in post-stroke brain remodeling. Task/stimulus-related fMRI, resting-state fMRI, or pharmacological MRI enables direct or indirect measurement of neuronal activation, functional connectivity, or neurotransmitter system responses, respectively. DTI allows estimation of the structural integrity and connectivity of white matter tracts. Together, these MRI methods provide an unprecedented means to (a) measure longitudinal changes in tissue structure and function close by and remote from ischemic lesion areas, (b) evaluate the organizational profile of neural networks after stroke, and (c) identify degenerative and restorative processes that affect post-stroke functional outcome. Besides, the availability of MRI in clinical institutions as well as research laboratories provides an optimal basis for translational research on stroke recovery. This review gives an overview of the current status and perspectives of fMRI and DTI applications to study brain reorganization in experimental stroke models.

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Restoration of function after stroke may be associated with structural remodeling of neuronal connections outside the infarcted area. However, the spatiotemporal profile of poststroke alterations in neuroanatomical connectivity in relation to functional recovery is still largely unknown. We performed in vivo magnetic resonance imaging (MRI)-based neuronal tract tracing with manganese in combination with immunohistochemical detection of the neuronal tracer wheatgerm agglutinin horseradish peroxidase (WGA-HRP), to assess changes in intra-and interhemispheric sensorimotor network connections from 2 to 10 weeks after unilateral stroke in rats. In addition, functional recovery was measured by repetitive behavioral testing. Four days after tracer injection in perilesional sensorimotor cortex, manganese enhancement and WGA-HRP staining were decreased in subcortical areas of the ipsilateral sensorimotor network at 2 weeks after stroke, which was restored at later time points. At 4 to 10 weeks after stroke, we detected significantly increased manganese enhancement in the contralateral hemisphere. Behaviorally, sensorimotor functions were initially disturbed but subsequently recovered and plateaued 17 days after stroke. This study shows that manganese-enhanced MRI can provide unique in vivo information on the spatiotemporal pattern of neuroanatomical plasticity after stroke. Our data suggest that the plateau stage of functional recovery is associated with restoration of ipsilateral sensorimotor pathways and enhanced interhemispheric connectivity.

Loss of function and subsequent spontaneous recovery after ischaemic stroke are associated with functional and structural alterations in brain tissue. Acute functional tissue damage involves distortion of key metabolic processes, such as oxidative glycolysis and neurotransmitter metabolism. Nevertheless, initially perturbed metabolism may be restored at later stages, e.g. in perilesional areas, which could play a key role in post-stroke recovery of brain function. The pattern of metabolic recovery in relation to ischaemic tissue damage, however, is basically unknown. The goal of our study was to reveal changes in glycolysis and glutamatergic neurotransmitter metabolism that could underlie post-stroke changes in functional status. We performed in vivo (1)H/(13)C magnetic resonance spectroscopic imaging (MRSI) during (13)C-labelled glucose infusion, and MRI, at 24 h (n = 6) and 3 weeks (n = 8) after stroke in a rat model to characterize alterations in baseline metabolite levels, glutamate (Glu) and glutamine (Gln) turnover, and active lactate (Lac) formation in areas with different degrees of ischaemic injury. Inside the lesion, we detected significant reductions in baseline metabolite levels, ongoing Lac formation and seriously diminished Glu and Gln turnover at both time points, indicative of irreversible functional tissue damage. In perilesional areas, significant decrease of N-acetyl aspartate (NAA) levels, and Glu and Gln turnover indicated neuronal dysfunction at 24 h. After 3 weeks, when animals showed significant neurological improvement, anaerobic glycolysis had ceased, NAA levels were normalized, Glu turnover was maintained and Gln turnover had recovered. These findings point out that early metabolic impairment in the lesion borderzone can be restored over time. Alterations in brain metabolism in perilesional areas probably contribute significantly to changes in functional status in stroke subjects, and may provide a gateway for therapeutic strategies directed at improvement of functional recovery after stroke.

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