Background and Purpose- The aim of the present study was to evaluate the relationship between normal-appearing white matter (NAWM) integrity and postischemic stroke recovery in 4 main domains including cognition, mood, gait, and dependency. Methods- A prospective study was conducted, including patients diagnosed for an ischemic supratentorial stroke on a 3T brain MRI performed 24 to 72 hours after symptom onset. Clinical assessment 1 year after stroke included a Montreal Cognitive Assessment, an Isaacs set test, a Zazzo cancelation task, a Hospital Anxiety and Depression scale, a 10-meter walking test, and a modified Rankin Scale (mRS). Diffusion tensor imaging parameters in the NAWM were computed using FMRIB (Functional Magnetic Resonance Imaging of the Brain) Diffusion Toolbox. The relationships between mean NAWM diffusion tensor imaging parameters and the clinical scores were assessed using linear and ordinal regression analyses, including the volumes of white matter hyperintensities, gray matter, and ischemic stroke as radiological covariates. Results- Two hundred seven subjects were included (66±13 years old; 67% men; median National Institutes of Health Stroke Scale score, 3; interquartile range, 2-6). In the models including only radiological variables, NAWM fractional anisotropy was associated with the mRS and the cognitive scores. After adjusting for demographic confounders, NAWM fractional anisotropy remained a significant predictor of mRS (β=-0.24; P=0.04). Additional path analysis showed that NAWM fractional anisotropy had a direct effect on mRS (β=-0.241; P=0.001) and a less important indirect effect mediating white matter hyperintensity burden. Similar results were found with mean diffusivity, axial diffusivity, and radial diffusivity. In further subgroup analyses, a relationship between NAWM integrity in widespread white matter tracts, mRS, and Isaacs set test was found in right hemispheric strokes. Conclusions- NAWM diffusion tensor imaging parameters measured early after an ischemic stroke are independent predictors of functional outcome and may be additional markers to include in studies evaluating poststroke recovery.

中文翻译：

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正常出现的白色物质完整性是缺血性卒中后结果的预测指标。

背景和目的-本研究的目的是评估正常表现的白质（NAWM）完整性与缺血性中风恢复在4个主要领域之间的关系，包括认知，情绪，步态和依赖性。方法-进行了一项前瞻性研究，包括在症状发作后24至72小时通过3T脑MRI诊断为缺血性幕上中风的患者。中风后1年的临床评估包括蒙特利尔认知评估，艾萨克斯设定测试，Zazzo取消任务，医院焦虑和抑郁量表，10米步行测试以及改良的兰金量表（mRS）。使用FMRIB（大脑功能磁共振成像）扩散工具箱计算NAWM中的扩散张量成像参数。使用线性和有序回归分析评估平均NAWM扩散张量成像参数与临床评分之间的关​​系，包括白质高信号，灰质和缺血性卒中的体积作为放射协变量。结果-纳入了207名受试者（66±13岁； 67％的男性；美国国立卫生研究院卒中量表评分中位数为3；四分位间距为2-6）。在仅包括放射学变量的模型中，NAWM分数各向异性与mRS和认知评分相关。在调整了人口混杂因素后，NAWM分数各向异性仍然是mRS的重要预测因子（β= -0.24； P = 0.04）。额外的路径分析表明，NAWM分数各向异性对mRS有直接影响（β= -0.241； P = 0。001）和次要的间接作用介导白质过度紧张负担。在平均扩散率，轴向扩散率和径向扩散率方面也发现了相似的结果。在进一步的亚组分析中，在右半球卒中发现了广泛分布的白质区，mRS和以撒定型测试之间的NAWM完整性之间的关系。结论-缺血性卒中早期测量的NAWM扩散张量成像参数是功能预后的独立预测因子，可能是评估卒中后恢复的研究中应包括的其他指标。并在右半球卒中发现了Isaacs固定测试。结论-缺血性中风后早期测量的NAWM扩散张量成像参数是功能结局的独立预测因子，可能是评估中风后恢复的研究中包括的其他标志物。并在右半球卒中发现了Isaacs固定测试。结论-缺血性中风后早期测量的NAWM扩散张量成像参数是功能结局的独立预测因子，可能是评估中风后恢复的研究中包括的其他标志物。