Early Prediction of Functional Outcome after Cerebral Small Arteries Infarctions Using Diffusion Tensor MRI Tractography

Abstract
Background: Lacunar Infarctions (LIs) are ischemic strokes caused by occlusion of the deep penetrating arteries. They constitute about 25% of all ischemic strokes and have variable consequences based on affected tracts disruptions.
Aim of Study: Were to assess the role of MRI Diffusion Tensor Imaging (DTI) fiber tractography as an early biomarker of LIs prognosis.
Patients and Methods: This work was conducted on 42 first-ever symptomatic motor or sensorimotor LIs patients (3 1 male and 11 female) submitted to stroke severity assess-ment using the National Institute of Health Stroke Scale (NIHSS), carotid duplex, brain MRI to determine LIs dimeter and occult small vessel disease imaging markers. Corticospinal Diffusion Tensor Tractography (CS-DTT) was done within 48 hours from stroke onset. Thirty-eight patients continued a 3-months follow-up schedule, at the end of which their physical dependences were assessed using the Modified Barthel Index (MBI) scale which were compared with the baseline assessment parameters to determine the prognostic biomarkers.
Results: Dependent patients' group showed significant increase in their age, BMI, carotid intima media thickness and white matter hyperintensities grade than independent patients' group. The FA ratio was the earliest parameter showed significant changes which were lower in dependent than independent patients' groups. On the other hand, each of ipsilateral DTI fractional anisotropy, mean diffusivity and fiber number showed non-significant differences.
Conclusion: Factors associated with poorer functional outcome after newly diagnosed LIs include advanced age, hypertension, obesity, premorbid physical inactivity, increased CIMT and the presence of imaging biomarkers of occult SVD. Reduced ipsilateral/contralateral FA ratio of the CS-DTT is a reliable early predictor of short-term functional outcome and motor disability after motor and sensorimotor LIs.