title: Diffusion tensor imaging as a prognostic biomarker for motor recovery and rehabilitation after stroke.
abstract: OBJECTIVE
  Despite improved acute treatment and new tools to facilitate recovery, most patients have motor deficits after stroke, often causing disability. However, motor impairment varies considerably among patients, and recovery in the acute/subacute phase is difficult to predict using clinical measures alone, particularly in severely impaired patients. Accurate early prediction of recovery would help rationalize rehabilitation goals and improve the design of trials testing strategies to facilitate recovery.
  
  
  METHODS
  We review the role of diffusion tensor imaging (DTI) in predicting motor recovery after stroke, in monitoring treatment response, and in evaluating white matter remodeling. We critically appraise DTI studies and discuss their limitations, and we explore directions for future study.
  
  
  RESULTS
  Growing evidence suggests that combining clinical scores with information about corticospinal tract (CST) integrity can improve predictions about motor outcome. The extent of CST damage on DTI and/or the overlap between the CST and a lesion are key prognostic factor that determines motor performance and outcome. Three main strategies to quantify stroke-related CST damage have been proposed: (i) measuring FA distal to the stroke area, (ii) measuring the number of fibers that go through the stroke with tractography, and (iii) measuring the overlap between the stroke and a CST map derived from healthy age- and gender-matched controls.
  
  
  CONCLUSIONS
  Recovery of motor function probably involves remodeling of the CST proper and/or a greater reliance on alternative motor tracts through spontaneous and treatment-induced plasticity. DTI-metrics represent promising clinical biomarkers to predict motor recovery and to monitor and predict the response to neurorehabilitative interventions.
authors.affiliation: Institute of Diagnostic Imaging (IDI) - Research Unit (IDIR), Parc Sanitari Pere Virgili, Barcelona, Spain. jpuigmd@gmail.com.|Girona Biomedical Research Institute (IDIBGI) - Medical Imaging, Hospital Universitari de Girona Dr. Josep Trueta, 17007, Girona, Spain. jpuigmd@gmail.com.
authors.forename: Josep
authors.initials: J
authors.lastname: Puig
authors.affiliation: Institute of Diagnostic Imaging (IDI) - Research Unit (IDIR), Parc Sanitari Pere Virgili, Barcelona, Spain.|Girona Biomedical Research Institute (IDIBGI) - Medical Imaging, Hospital Universitari de Girona Dr. Josep Trueta, 17007, Girona, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Blasco
authors.affiliation: Neuroimaging and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Schlaug
authors.affiliation: Department of Medicine, Centre for Brain Research, University of Auckland, Auckland, New Zealand.
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Stinear
authors.affiliation: Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain.
authors.forename: Pepus
authors.initials: P
authors.lastname: Daunis-I-Estadella
authors.affiliation: Girona Biomedical Research Institute (IDIBGI) - Medical Imaging, Hospital Universitari de Girona Dr. Josep Trueta, 17007, Girona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Biarnes
authors.affiliation: Department of Rehabilitation, Dr. Josep Trueta University Hospital, Girona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Figueras
authors.affiliation: Department of Neurology, Dr. Josep Trueta University Hospital, Girona, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Serena
authors.affiliation: Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Hernández-Pérez
authors.affiliation: La Fe Polytechnics and University Hospital, Valencia, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Alberich-Bayarri
authors.affiliation: Department of Neurology, A Coruña University Hospital, La Coruña, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Castellanos
authors.affiliation: UCLA Stroke Center, Los Angeles, CA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Götz
authors.initials: G
authors.lastname: Thomalla
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Nael
authors.affiliation: Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Girona Biomedical Research Institute (IDIBGI) - Medical Imaging, Hospital Universitari de Girona Dr. Josep Trueta, 17007, Girona, Spain.|Institute of Diagnostic Imaging (IDI), Dr. Josep Trueta University Hospital, Girona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pedraza
mesh_terms: D056324:Diffusion Tensor Imaging / Q000379:methods*; D006801:Humans; D011379:Prognosis; D020127:Recovery of Function; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D000071939:Stroke Rehabilitation
keywords: Diffusion tensor imaging; MRI; Recovery; Rehabilitation; Stroke