Role of cerebral reserve assessed using diffusion-weighted magnetic resonance imaging in determining the rehabilitation potential of acute ischemic stroke

Abstract

Fractional anisotropy (FA) estimated using diffusion tensor magnetic resonance imaging (dMRI) is considered as a promising biomarker in ischemic stroke (IS). The basis of this study is the assumption that the assessment of FA indices for different white matter tracts will be able to predict the main aspects of the rehabilitation potential even without determining the structural and functional bases of these influences.Objective: to study the diagnostic significance of changes in FA indices to assess various aspects of the rehabilitation potential in acute IS.Patients and methods. Examinations were made in 100 patients with IS and in 10 individuals without stroke and cognitive impairment. All the patients underwent dMRI and assessments of rehabilitation potential indicators on days 3 and 10 of the disease and at discharge.Results and discussion. The indices of FA of the ipsilateral upper longitudinal and cingulum bundles, FA and the size of an infarct focus, asymmetry of FA of the cingulum bundle (rFA), corticospinal tract (at the level of the knee of the internal capsule and bridge) and the anterior limb of the internal capsule, as well as the FA of the splenium and knee of the internal capsule of the intact hemisphere are of the most value for the functional outcome of acute IS. The microstructure of these zones determines the state of most rehabilitation domains. With respect to global outcome, the integrity of the associative tracts of the affected hemisphere is more valuable than the microstructure of the intact hemisphere and rFA. The tracts of the intact hemisphere are of particular importance for the restoration of complex rehabilitation spheres, such as cognitive status and daily living and social skills, which is necessary to ensure patient independence.Conclusion. The FA indices of the tracts under study seem to be a clinically acceptable biomarker of various aspects of the rehabilitation potential in acute IS.

Does a Cognitive Network Contribute to Motor Recovery After Ischemic Stroke?

“…19,20 In diffusion tensor imaging study of stroke patients, the integrity of some tracts correlated with both motor and cognitive states. 21 Considering the functional relationship through previous studies mentioned above, motor function cannot be separated from cognitive function. In this respect, it is reasonable for cognition-related networks to be involved in motor recovery in our large-network study.…”

Diffusion Tensor Imaging as a Prognostic Tool for Recovery in Acute and Hyperacute Stroke

“…DTI was conducted in 58 patients within 80 h post-stroke, with ROIs located at the cerebral peduncle and a stretch of the CST caudal to each stroke lesion; the slope of the FA laterality and apparent diffusion coefficient (ADC) laterality indices of the nearest-5-slices (N5S) could predict 3-month UE-FM score weakly. In another study including 100 patients with ischemic stroke at the acute phase and applying DTI tractography to reconstruct both CST and commissural and associative WM tracts, Kulesh and colleagues found that the integrity (FA) of the integrity of the associative tracts of the affected hemisphere is more valuable than the microstructure of the intact hemisphere and the rFA for the prediction of global outcome whereas the integrity of the tracts of the intact hemisphere are important for the restoration of complex rehabilitation spheres, such as cognitive status and daily living and social skills [ 63 ].…”

Current approaches to diagnosing in intracerebral hemorrhage

“…систолическое АД при поступлении в стационар и в последующие 3 сут по сравнению с таковым при других причинах инсульта [18]. Ранние стадии поражения головного мозга при АГ могут не сопровождаться макроструктурными маркерами ЦБМС, но при этом ухудшаются его микроструктура и перфузия [19], что определяет целесообразность применения соответствующих МРТ-модальностей -диффузионновзвешенного изображения с оценкой фракционной анизотропии и средней диффузии, а также бесконтрастного перфузионного исследования по методу меченых спинов [20,21].…”