title: Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes.
abstract: OBJECTIVE
  Acute infarct volume, often proposed as a biomarker for evaluating novel interventions for acute ischemic stroke, correlates only moderately with traditional clinical end points, such as the modified Rankin Scale. We hypothesized that the topography of acute stroke lesions on diffusion-weighted magnetic resonance imaging may provide further information with regard to presenting stroke severity and long-term functional outcomes.
  
  
  METHODS
  Data from a prospective stroke repository were limited to acute ischemic stroke subjects with magnetic resonance imaging completed within 48 hours from last known well, admission NIH Stroke Scale (NIHSS), and 3-to-6 months modified Rankin Scale scores. Using voxel-based lesion symptom mapping techniques, including age, sex, and diffusion-weighted magnetic resonance imaging lesion volume as covariates, statistical maps were calculated to determine the significance of lesion location for clinical outcome and admission stroke severity.
  
  
  RESULTS
  Four hundred ninety subjects were analyzed. Acute stroke lesions in the left hemisphere were associated with more severe NIHSS at admission and poor modified Rankin Scale at 3 to 6 months. Specifically, injury to white matter (corona radiata, internal and external capsules, superior longitudinal fasciculus, and uncinate fasciculus), postcentral gyrus, putamen, and operculum were implicated in poor modified Rankin Scale. More severe NIHSS involved these regions, as well as the amygdala, caudate, pallidum, inferior frontal gyrus, insula, and precentral gyrus.
  
  
  CONCLUSIONS
  Acute lesion topography provides important insights into anatomic correlates of admission stroke severity and poststroke outcomes. Future models that account for infarct location in addition to diffusion-weighted magnetic resonance imaging volume may improve stroke outcome prediction and identify patients likely to benefit from aggressive acute intervention and personalized rehabilitation strategies.
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.). ona@nmr.mgh.harvard.edu.
authors.forename: Ona
authors.initials: O
authors.lastname: Wu
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Lisa
authors.initials: L
authors.lastname: Cloonan
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Steven J T
authors.initials: SJ
authors.lastname: Mocking
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Mark J R J
authors.initials: MJ
authors.lastname: Bouts
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: William A
authors.initials: WA
authors.lastname: Copen
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Cougo-Pinto
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Kaitlin
authors.initials: K
authors.lastname: Fitzpatrick
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Allison
authors.initials: A
authors.lastname: Kanakis
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Schaefer
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.affiliation: From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Rost
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology; D013997:Time Factors
keywords: MRI; VLSM; acute stroke; statistical model; topography