Diffusion tensor imaging as a prognostic biomarker for motor recovery and rehabilitation after stroke
Por:
Puig, J, Blasco, G, Schlaug, G, Stinear, CM, Daunis-i-Estadella, P, Biarnes, C, Figueras, J, Serena, J, Hernandez-Perez, M, Alberich-Bayarri, A, Castellanos, M, Liebeskind, DS, Demchuk, AM, Menon, BK, Thomalla, G, Nael, K, Wintermark, M and Pedraza, S
Publicada:
1 abr 2017
Resumen:
Purpose Despite improved acute treatment and new tools to facilitate recovery, most patients have motor deficits after stroke, often causing disability. However, motor impairment varies considerably among patients, and recovery in the acute/subacute phase is difficult to predict using clinical measures alone, particularly in severely impaired patients. Accurate early prediction of recovery would help rationalize rehabilitation goals and improve the design of trials testing strategies to facilitate recovery.
Methods We review the role of diffusion tensor imaging (DTI) in predicting motor recovery after stroke, in monitoring treatment response, and in evaluating white matter remodeling. We critically appraise DTI studies and discuss their limitations, and we explore directions for future study.
Results Growing evidence suggests that combining clinical scores with information about corticospinal tract (CST) integrity can improve predictions about motor outcome. The extent of CST damage on DTI and/or the overlap between the CST and a lesion are key prognostic factor that determines motor performance and outcome. Three main strategies to quantify stroke-related CST damage have been proposed: (i) measuring FA distal to the stroke area, (ii) measuring the number of fibers that go through the stroke with tractography, and (iii) measuring the overlap between the stroke and a CST map derived from healthy age- and gender-matched controls.
Conclusion Recovery of motor function probably involves remodeling of the CST proper and/or a greater reliance on alternative motor tracts through spontaneous and treatment induced plasticity. DTI-metrics represent promising clinical biomarkers to predict motor recovery and to monitor and predict the response to neurorehabilitative interventions.
Filiaciones:
Puig, J:
Parc Sanitari Pere Virgili, Res Unit IDIR, IDI, Barcelona, Spain
Hosp Univ Girona Dr Josep Trueta, Girona Biomed Res Inst IDIBGI, Med Imaging, Girona 17007, Spain
Blasco, G:
Parc Sanitari Pere Virgili, Res Unit IDIR, IDI, Barcelona, Spain
Hosp Univ Girona Dr Josep Trueta, Girona Biomed Res Inst IDIBGI, Med Imaging, Girona 17007, Spain
Schlaug, G:
Beth Israel Deaconess Med Ctr, Dept Neurol, Neuroimaging & Stroke Recovery Lab, Boston, MA 02215 USA
Harvard Med Sch, Boston, MA 02215 USA
Stinear, CM:
Univ Auckland, Dept Med, Ctr Brain Res, Auckland, New Zealand
Daunis-i-Estadella, P:
Univ Girona, Dept Comp Sci Appl Math & Stat, Girona, Spain
Biarnes, C:
Hosp Univ Girona Dr Josep Trueta, Girona Biomed Res Inst IDIBGI, Med Imaging, Girona 17007, Spain
Figueras, J:
Dr Josep Trueta Univ Hosp, Dept Rehabil, Girona, Spain
Serena, J:
Dr Josep Trueta Univ Hosp, Dept Neurol, Girona, Spain
:
Germans Trias & Pujol Univ Hosp, Stroke Unit, Badalona, Spain
Alberich-Bayarri, A:
La Fe Polytech & Univ Hosp, Valencia, Spain
Castellanos, M:
A Coruna Univ Hosp, Dept Neurol, La Coruna, Spain
Liebeskind, DS:
UCLA Stroke Ctr, Los Angeles, CA USA
Demchuk, AM:
Univ Calgary, Hotchkiss Brain Inst, Calgary Stroke Program, Calgary, AB, Canada
Menon, BK:
Univ Calgary, Hotchkiss Brain Inst, Calgary Stroke Program, Calgary, AB, Canada
Thomalla, G:
Univ Med Ctr Hamburg Eppendorf, Dept Neurol, Hamburg, Germany
Nael, K:
Icahn Sch Med Mt Sinai, Dept Radiol, New York, NY 10029 USA
Wintermark, M:
Stanford Univ, Dept Radiol, Neuroradiol Div, Stanford, CA 94305 USA
Pedraza, S:
Hosp Univ Girona Dr Josep Trueta, Girona Biomed Res Inst IDIBGI, Med Imaging, Girona 17007, Spain
Dr Josep Trueta Univ Hosp, IDI, Girona, Spain
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