Diffusion Tensor Fractional Anisotropy in the Superior Longitudinal Fasciculus Correlates with Functional Independence Measure Cognition Scores in Patients with Cerebral Infarction

Abstract

Background: This study aimed to determine the relationship between fiber tract degeneration measured by diffusion-tensor imaging (DTI) and outcome of patients after cerebral infarction.

Methods: Fractional anisotropy (FA) maps were generated by DTI in patients 14-21 days after the first infarction and were analyzed by tract-based spatial statistics (TBSS). Mean FA values within the corticospinal tract (CST) and the superior longitudinal fasciculus (SLF) were extracted from individual TBSS data. Relationships between FA ratios (rFAs, lesioned to non-lesioned hemisphere) and outcomes assessed by Brunnstrom stage (BRS) and Functional Independence Measure (FIM) motor and cognition scores were examined using Spearman's rank correlation test.

Results: Forty patients (21 left and 19 right hemisphere lesions) were entered into an analytical database. BRS ranged from 1 to 6 (median, 5) for shoulder, elbow, or forearm; from 2 to 6 (median, 4.5) for hand or finger; and from 3 to 6 (median, 5) for lower extremity. FIM motor ranged from 51 to 91 (median, 79.5), and FIM cognition ranged from 16 to 35 (median, 29). rFA values in the CST ranged from .692 to 1.053 (median, .933), and those in the SLF ranged from .778 to 1.076 (median, .965). Mann-Whitney U test (P <.05) revealed no significant differences between the left and the right hemisphere lesion groups. Individual rFA values in the CST correlated with BRS scores (r = .585-0.654), whereas those in the SLF correlated with FIM cognition scores (r = .409, P <.05).

Conclusions: DTI-FA values in the SLF and CST may be useful for outcome prediction of cognitive function and extremity function, respectively.

Keywords: assessment; cognition; outcome; prognosis; stroke.