Impaired corticospinal tract in chronic ankle instability: A diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) study at 7.0 Tesla

Electrophysiological studies have revealed that abnormal function of the corticospinal pathway might contribute to chronic ankle instability, but structural evidence underlying the abnormality is lacking. The purpose of this study was to quantitate microstructural differences between corticospinal tracts in patients with chronic ankle instability and healthy controls.Cross-sectional.Seventeen patients with chronic ankle instability and sixteen healthy controls underwent diffusion weighted-imaging scans using an ultra-high-field 7.0 Tesla magnetic resonance imaging scanner. We focused on corticospinal tracts as a region of interest and performed classical diffusion tensor imaging and the advanced neurite orientation dispersion and density imaging outcomes that measured the microstructure of white matter tracts. Correlation analyses were also performed between the significantly different diffusion outcomes in both groups.The patients with chronic ankle instability showed significantly lower fractional anisotropy (p-corrected = 0.045) and higher orientation dispersion index (p-corrected = 0.033) when compared with healthy controls. These two measures were significantly correlated in the healthy controls (r = -0.56, p = 0.024) and the CAI patient group (r = -0.53, p = 0.029).This study revealed that the contralateral corticospinal tract of the unstable ankle in patients with chronic ankle instability exhibited impaired integrity, which was associated with abnormally organized neurites. We propose that this is a useful target for the clinical assessment of chronic ankle instability and the development of targeted neuromuscular rehabilitation.