Abstract
Background: Clinical assessment scores after acute ischemic stroke are only moderately correlated with structural brain damage since lesion location is also an important confounding factor. Many studies have investigated gray matter eloquence but, general understanding about the importance of specific white matter (WM) tract involvement is limited. The aim of this study was to investigate the eloquence of major WM tracts with respect to 24 hours post-stroke NIHSS. Methods: Lesions in follow-up FLAIR MRI datasets acquired 1-7 days after acute stroke onset due to proximal MCA or ICA occlusion were manually segmented and non-linearly registered to a common atlas. Voxel-based lesion-symptom mapping (VLSM) using sparse canonical correlation analysis was used to generate a statistical eloquence map with normalized t-scores ranging from 0 to 1 with the 24h NIHSS as outcome score. The JHU probabilistic WM atlas was used to quantify the individual tract eloquence. Results: 96 patients were included in this study (50 females, mean age 66.4±14.0 years, median NIHSS 5, IQR 2-9.5). Multivariate VLSM resulted in a major left-hemispheric and smaller right-hemispheric cluster of significant voxels overlapping with four WM tracts. The left corticospinal tract (motor function) showed an overlap of 3.52% (maximum t-score: 0.31; mean: 0.17±0.05), the right corticospinal tract an overlap of 7.33% (maximum t-score: 0.54; mean: 0.26±0.01), the left anterior thalamic radiation (sensory and motor relay) an overlap of 5.89% (maximum t-score: 0.44, mean: 0.18±0.07), and the inferior fronto-occipital fasciculus (auditory and visual association) an overlap of 21.31% (maximum t-score: 0.34, mean: 0.21±0.06). Conclusions: The significantly affected WM tracts identified are related to motor and cognition function, predominantly assessed by NIHSS, highlighting the importance of white matter tract involvement for recovery and rehabilitation.
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