title: Acute damage to the posterior limb of the internal capsule on diffusion tensor tractography as an early imaging predictor of motor outcome after stroke.
abstract: OBJECTIVE
  Early prediction of motor outcome is of interest in stroke management. We aimed to determine whether lesion location at DTT is predictive of motor outcome after acute stroke and whether this information improves the predictive accuracy of the clinical scores.
  
  
  METHODS
  We evaluated 60 consecutive patients within 12 hours of middle cerebral artery stroke onset. We used DTT to evaluate CST involvement in the motor cortex and premotor cortex, centrum semiovale, corona radiata, and PLIC and in combinations of these regions at admission, at day 3, and at day 30. Severity of limb weakness was assessed by using the motor subindex scores of the National Institutes of Health Stroke Scale (5a, 5b, 6a, 6b). We calculated volumes of infarct and fractional anisotropy values in the CST of the pons.
  
  
  RESULTS
  Acute damage to the PLIC was the best predictor associated with poor motor outcome, axonal damage, and clinical severity at admission (P < .001). There was no significant correlation between acute infarct volume and motor outcome at day 90 (P = .176, r = 0.485). The sensitivity, specificity, and positive and negative predictive values of acute CST involvement at the level of the PLIC for motor outcome at day 90 were 73.7%, 100%, 100%, and 89.1%, respectively. In the acute stage, DTT predicted motor outcome at day 90 better than the clinical scores (R(2) = 75.50, F = 80.09, P < .001).
  
  
  CONCLUSIONS
  In the acute setting, DTT is promising for stroke mapping to predict motor outcome. Acute CST damage at the level of the PLIC is a significant predictor of unfavorable motor outcome.
authors.affiliation: Departments of Radiology, Girona Biomedical Research Institute, Hospital Universitari Dr. Josep Trueta, Spain. jpuigalcantara@yahoo.es
authors.forename: J
authors.initials: J
authors.lastname: Puig
authors.forename: S
authors.initials: S
authors.lastname: Pedraza
authors.forename: G
authors.initials: G
authors.lastname: Blasco
authors.forename: J
authors.initials: J
authors.lastname: Daunis-I-Estadella
authors.forename: F
authors.initials: F
authors.lastname: Prados
authors.forename: S
authors.initials: S
authors.lastname: Remollo
authors.forename: A
authors.initials: A
authors.lastname: Prats-Galino
authors.forename: G
authors.initials: G
authors.lastname: Soria
authors.forename: I
authors.initials: I
authors.lastname: Boada
authors.forename: M
authors.initials: M
authors.lastname: Castellanos
authors.forename: J
authors.initials: J
authors.lastname: Serena
mesh_terms: D000368:Aged; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D020772:Internal Capsule / Q000473:pathology*; D008297:Male; D009069:Movement Disorders / Q000150:complications* / Q000473:pathology*; D011379:Prognosis; D020127:Recovery of Function; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000473:pathology*