title: The association between lesion location and functional outcome after ischemic stroke.
abstract: BACKGROUND
  Infarct location has a critical effect on patient outcome after ischemic stroke, but the study of its role independent of overall lesion volume is challenging. We performed a retrospective, hypothesis-generating study of the effect of infarct location on three-month functional outcome in a pooled analysis of the EPITHET and DEFUSE studies.
  
  
  METHODS
  Posttreatment MRI diffusion lesions were manually segmented and transformed into standard-space. A novel composite brain atlas derived from three standard brain atlases and encompassing 132 cortical and sub-cortical structures was used to segment the transformed lesion into different brain regions, and calculate the percentage of each region infarcted. Classification and Regression Tree (CART) analysis was performed to determine the important regions in each hemisphere associated with nonfavorable outcome at day 90 (modified Rankin score [mRS] > 1).
  
  
  RESULTS
  Overall, 152 patients (82 left hemisphere) were included. Median diffusion lesion volume was 37·0 ml, and median baseline National Institutes of Health Stroke Score was 13. In the left hemisphere, the strongest determinants of nonfavorable outcome were infarction of the uncinate fasciculus, followed by precuneus, angular gyrus and total diffusion lesion volume. In the right hemisphere, the strongest determinants of nonfavorable outcome were infarction of the parietal lobe followed by the putamen.
  
  
  CONCLUSIONS
  Assessment of infarct location using CART demonstrates regional characteristics associated with poor outcome. Prognostically important locations include limbic, default-mode and language areas in the left hemisphere, and visuospatial and motor regions in the right hemisphere.
authors.affiliation: Department of Neurology, Melbourne Brain Centre @ Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia.
authors.forename: Nawaf
authors.initials: N
authors.lastname: Yassi
authors.affiliation: Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
authors.affiliation: Department of Neurology, Melbourne Brain Centre @ Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia.
authors.forename: Bruce C V
authors.initials: BC
authors.lastname: Campbell
authors.affiliation: Departement of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia.
authors.forename: Gagan
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Department of Neurology and Neurological Sciences and Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.affiliation: Departement of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Desmond
authors.affiliation: Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Parsons
authors.affiliation: Department of Neurology and Neurological Sciences and Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.affiliation: Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Donnan
authors.affiliation: Department of Neurology, Melbourne Brain Centre @ Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D007839:Functional Laterality; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: MRI; brain atlas; infarct location; prognosis; recovery; stroke