Predictive value of corticospinal tract integrity and clinical factors for post-stroke motor recovery using diffusion tensor imaging

초록

Objective: This study aimed to investigate whether initial corticospinal tract (CST) integrity and clinical assessments are associated with motor recovery after stroke and whether follow-up CST evaluation provides additional explanatory value for predicting outcomes. Methods: Eighty patients with stroke underwent diffusion tensor tractography (DTT) during the subacute and chronic phases. Motor recovery at 6 months was assessed using the Fugl-Meyer Assessment (FMA). Baseline CST integrity was quantified using the fiber-number ratio (FNr). Multivariable regression analyses were conducted to determine the explanatory contributions of baseline and follow-up CST integrity. Among patients with severe motor impairment (initial FMA-upper score <20), motor outcomes were compared between the preserved and disrupted CST groups. Results: Initial FNr, FMA scores, and muscle strength were independently associated with motor recovery. The inclusion of follow-up CST integrity did not significantly increase the proportion of explained variance in motor outcomes. Among patients with severe impairment, those with preserved CST integrity exhibited significantly higher FMA total scores. Conclusions: Initial CST integrity and clinical factors were independently associated with motor recovery, whereas follow-up DTT did not provide significant additional explanatory value. Early assessments may inform prognostic evaluation and guide rehabilitation planning, even in patients with severe stroke. Significance: Early CST integrity is independently associated with motor recovery, supporting its potential as a prognostic biomarker in stroke rehabilitation.

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