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Multicenter Study
. 2023 Sep;94(3):572-584.
doi: 10.1002/ana.26721. Epub 2023 Jun 27.

Lesion Network Mapping for Neurological Deficit in Acute Ischemic Stroke

Lingling Ding  1   2   3 , Hao Liu  4 , Jing Jing  1   2   3 , Yong Jiang  1   2 , Xia Meng  1   2 , Yaojing Chen  5 , Xingquan Zhao  1   2   3 , Haijun Niu  4 , Tao Liu  4 , Yongjun Wang  1   2   3   6   7   8 , Zixiao Li  1   2   3   9   10
Affiliations
Multicenter Study

Lesion Network Mapping for Neurological Deficit in Acute Ischemic Stroke

Lingling Ding et al. Ann Neurol. 2023 Sep.

Abstract

Objective: To create a comprehensive map of strategic lesion network localizations for neurological deficits, and identify prognostic neuroimaging biomarkers to facilitate the early detection of patients with a high risk of poor functional outcomes in acute ischemic stroke (AIS).

Methods: In a large-scale multicenter study of 7,807 patients with AIS, we performed voxel-based lesion-symptom mapping, functional disconnection mapping (FDC), and structural disconnection mapping (SDC) to identify distinct lesion and network localizations for National Institutes of Health Stroke Scale (NIHSS) score. Impact scores were calculated based on the odds ratios or t-values of voxels from voxel-based lesion-symptom mapping, FDC, and SDC results. Ordinal regression models were used to investigate the predictive value of the impact scores on functional outcome (defined as the modified Rankin score at 3 months).

Results: We constructed lesion, FDC, and SDC maps for each item of the NIHSS score, which provided insights into the neuroanatomical substrate and network localization of neurological function deficits after AIS. The lesion impact score of limb ataxia, the SDC impact score of limb deficit, and FDC impact score of sensation and dysarthria were significantly associated with modified Rankin Scale at 3 months. Adding the SDC impact score, FDC impact score, and lesion impact score to the NIHSS total score improved the performance in predicting functional outcomes, as compared with using the NIHSS score alone.

Interpretation: We constructed comprehensive maps of strategic lesion network localizations for neurological deficits that were predictive of functional outcomes in AIS. These results may provide specifically localized targets for future neuromodulation therapies. ANN NEUROL 2023;94:572-584.

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References

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