Ann Rehabil Med.  2016 Feb;40(1):126-134. 10.5535/arm.2016.40.1.126.

Comparison of Diffusion Tensor Tractography and Motor Evoked Potentials for the Estimation of Clinical Status in Subacute Stroke

• Chun KS
• Lee YT
• Park JW
• Lee JY
• Park CH
• Yoon KJ

• KMID: 2155175
• DOI: http://doi.org/10.5535/arm.2016.40.1.126

Abstract

OBJECTIVE
To compare diffusion tensor tractography (DTT) and motor evoked potentials (MEPs) for estimation of clinical status in patients in the subacute stage of stroke.
METHODS
Patients with hemiplegia due to stroke who were evaluated using both DTT and MEPs between May 2012 and April 2015 were recruited. Clinical assessments investigated upper extremity motor and functional status. Motor status was evaluated using Medical Research Council grading and the Fugl-Meyer Assessment of upper limb and hand (FMA-U and FMA-H). Functional status was measured using the Modified Barthel Index (MBI). Patients were classified into subgroups according to DTT findings, MEP presence, fractional anisotropy (FA) value, FA ratio (rFA), and central motor conduction time (CMCT). Correlations of clinical assessments with DTT parameters and MEPs were estimated.
RESULTS
Fifty-five patients with hemiplegia were recruited. In motor assessments (FMA-U), MEPs had the highest sensitivity and negative predictive value (NPV) as well as the second highest specificity and positive predictive value (PPV). CMCT showed the highest specificity and PPV. Regarding functional status (MBI), FA showed the highest sensitivity and NPV, whereas CMCT had the highest specificity and PPV. Correlation analysis showed that the resting motor threshold (RMT) ratio was strongly associated with motor status of the upper limb, and MEP parameters were not associated with MBI.
CONCLUSION
DTT and MEPs could be suitable complementary modalities for analyzing the motor and functional status of patients in the subacute stage of stroke. The RMT ratio was strongly correlated with motor status.

Keyword

Diffusion tractography; Motor evoked potentials; Resting motor threshold; Stroke; Corticospinal tract

MeSH Terms

Anisotropy
Diffusion Tensor Imaging
Diffusion*
Evoked Potentials, Motor*
Hand
Hemiplegia
Humans
Pyramidal Tracts
Sensitivity and Specificity
Stroke*
Upper Extremity

Figure

• 

  Fig. 1 Comparisons of clinical assessments between subgroups. All clinical assessments showed significant differences between them. MRC-U, Medical Research Council sum of upper limb; FMA-U, Fugl-Meyer Assessment of upper limb; FMA-H, Fugl-Meyer Assessment of hand; DTT, diffusion tensor tractography; FA, fractional anisotropy; rFA, fractional anisotropy ratio; MEP, motor evoked potential; CMCT, central motor conduction time. *p<0.05 by independent t-test.

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