Behavioural deficits in stroke reflect both structural damage at the site of injury, and widespread network dysfunction caused by structural, functional, and metabolic disconnection. Two recent methods allow for the estimation of structural and functional disconnection from clinical structural imaging. This is achieved by embedding a patient’s lesion into an atlas of functional and structural connections in healthy subjects, and deriving the ensemble of structural and functional connections that pass through the lesion, thus indirectly estimating its impact on the whole brain connectome. This indirect assessment of network dysfunction is more readily available than direct measures of functional and structural connectivity obtained with functional and diffusion MRI, respectively, and it is in theory applicable to a wide variety of disorders. To validate the clinical relevance of these methods, we quantified the prediction of behavioural deficits in a prospective cohort of 132 first-time stroke patients studied at 2 weeks post-injury (mean age 52.8 years, range 22–77; 63 females; 64 right hemispheres). Specifically, we used multivariate ridge regression to relate deficits in multiple functional domains (left and right visual, left and right motor, language, spatial attention, spatial and verbal memory) with the pattern of lesion and indirect structural or functional disconnection. In a subgroup of patients, we also measured direct alterations of functional connectivity with resting-state functional MRI. Both lesion and indirect structural disconnection maps were predictive of behavioural impairment in all domains (0.16 < R² < 0.58) except for verbal memory (0.05 < R² < 0.06). Prediction from indirect functional disconnection was scarce or negligible (0.01 < R² < 0.18) except for the right visual field deficits (R² = 0.38), even though multivariate maps were anatomically plausible in all domains. Prediction from direct measures of functional MRI functional connectivity in a subset of patients was clearly superior to indirect functional disconnection. In conclusion, the indirect estimation of structural connectivity damage successfully predicted behavioural deficits post-stroke to a level comparable to lesion information. However, indirect estimation of functional disconnection did not predict behavioural deficits, nor was a substitute for direct functional connectivity measurements, especially for cognitive disorders.

中文翻译：

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根据病变和间接结构和功能脱节预测中风后缺陷。


中风的行为缺陷既反映了损伤部位的结构损伤，也反映了结构、功能和代谢断开引起的广泛的网络功能障碍。最近的两种方法允许估计临床结构成像的结构和功能脱节。这是通过将患者的病变嵌入健康受试者的功能和结构连接图谱中，并推导穿过病变的结构和功能连接的集合，从而间接估计其对整个大脑连接组的影响来实现的。这种对网络功能障碍的间接评估比分别通过功能性 MRI 和扩散 MRI 获得的功能和结构连接的直接测量更容易获得，并且理论上适用于多种疾病。为了验证这些方法的临床相关性，我们对损伤后 2 周研究的 132 名首次中风患者的前瞻性队列（平均年龄 52.8 岁，范围 22-77；63 名女性；64 名右侧儿童）的行为缺陷预测进行了量化。半球）。具体来说，我们使用多元岭回归将多个功能域（左右视觉、左右运动、语言、空间注意力、空间和言语记忆）的缺陷与病变模式和间接结构或功能脱节联系起来。在一组患者中，我们还通过静息态功能 MRI 测量了功能连接的直接变化。病变和间接结构断开图均可预测除言语记忆 (0.05 < R ² < 0.06) 之外的所有领域 (0.16 < R ² < 0.58) 的行为障碍。 尽管多元图在所有领域中在解剖学上都是合理的，但除了右视野缺陷（R ² = 0.38）之外，间接功能断开的预测很少或可以忽略不计（0.01 < R ² < 0.18）。对一部分患者进行功能性 MRI 功能连接的直接测量进行的预测明显优于间接功能性断开。总之，结构连接损伤的间接估计成功地将中风后的行为缺陷预测到与病变信息相当的水平。然而，功能断开的间接估计并不能预测行为缺陷，也不能替代直接的功能连接测量，尤其是对于认知障碍。