title: The real estate factor: quantifying the impact of infarct location on stroke severity.
abstract: OBJECTIVE
  The severity of the neurological deficit after ischemic stroke is moderately correlated with infarct volume. In the current study, we sought to quantify the impact of location on neurological deficit severity and to delineate this impact from that of volume.
  
  
  METHODS
  We developed atlases consisting of location-weighted values indicating the relative importance in terms of neurological deficit severity for every voxel of the brain. These atlases were applied to 80 first-ever ischemic stroke patients to produce estimates of clinical deficit severity. Each patient had an MRI and National Institutes of Health Stroke Scale (NIHSS) examination just before or soon after hospital discharge. The correlation between the location-based deficit predictions and measured neurological deficit (NIHSS) scores were compared with the correlation obtained using volume alone to predict the neurological deficit.
  
  
  RESULTS
  Volume-based estimates of neurological deficit severity were only moderately correlated with measured NIHSS scores (r=0.62). The combination of volume and location resulted in a significantly better correlation with clinical deficit severity (r=0.79, P=0.032).
  
  
  CONCLUSIONS
  The atlas methodology is a feasible way of integrating infarct size and location to predict stroke severity. It can estimate stroke severity better than volume alone.
authors.affiliation: Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and the Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Boston, MA, USA.
authors.forename: Nina M
authors.initials: NM
authors.lastname: Menezes
authors.forename: Hakan
authors.initials: H
authors.lastname: Ay
authors.forename: Ming
authors.initials: M
authors.lastname: Wang Zhu
authors.forename: Chloe J
authors.initials: CJ
authors.lastname: Lopez
authors.forename: Aneesh B
authors.initials: AB
authors.lastname: Singhal
authors.forename: Jari O
authors.initials: JO
authors.lastname: Karonen
authors.forename: Hannu J
authors.initials: HJ
authors.lastname: Aronen
authors.forename: Yawu
authors.initials: Y
authors.lastname: Liu
authors.forename: Juho
authors.initials: J
authors.lastname: Nuutinen
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Koroshetz
authors.forename: A Gregory
authors.initials: AG
authors.lastname: Sorensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000716:Anatomy, Artistic; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D020520:Brain Infarction / Q000473:pathology* / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000639:trends; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D013223:Statistics as Topic