Diffusion tensor pyramidal tractography in patients with anterior choroidal artery infarcts

BACKGROUND AND PURPOSE: Anterior choroidal artery (AchoA) stroke often evolves into undulating hemipareses, which sometimes progress to high-grade hemiparesis or hemiplegia but may also completely regress. Spatial relationships of AchoA infarcts to corticospinal tracts (CSTs) and CST integrity were investigated with diffusion tensor imaging (DTI) to identify prognostic parameters related to diffusion anisotropy changes in AchoA stroke. MATERIALS AND METHODS: Twenty-five AchoA stroke patients were prospectively examined with 3T. DTI and diffusion tensor tractography (DTT) within a 3-day mean interval after onset. Analysis included the following: 1) stroke size on diffusion-weighted imaging; 2) fractional anisotropy (FA) and apparent diffusion coefficients at the largest stroke extents versus contralateral homologous structures; 3) lesion location related to CST ("involvement"); 4) amount of fiber trajectories of affected versus nonaffected CST ("fiber ratio"); and 5) presence of ipsilateral fiber disruption. Imaging findings were related to clinical status 3 months after symptom onset with respect to favorable, moderate, or unfavorable motor outcome. RESULTS: FA differences (clue to FA reduction in the affected versus nonaffected hemisphere) were significantly higher for patients with unfavorable outcome (P =.03). Patients with favorable outcome had nearly symmetrical FA. CSTs were involved in ischemic lesions in all but 2 patients (complete involvement, n = 3; partial, n = 20). Two CSTs were completely disrupted, and both patients were hemiplegic (no disruption, n = 14; partial disruption, n = 9). Fiber disruption and CST involvement correlated negatively with motor score after AchoA stroke (P <.01), whereas infarct size did not. CONCLUSION: DTT may explain resulting motor dysfunction in patients with AchoA infarcts with more notably decreased FA being an indicator for unfavorable outcome.