Association Between Changes in White Matter Volume Detected With Diffusion Tensor–Based Morphometry and Motor Recovery After Stroke

Diffusion tensor-based morphometry (DTBM) provides a more accurate assessment of volumetric changes in white matter structures than conventional T1-based TBM techniques. We sought to determine whether DTBM could detect volume loss in the corticospinal tract (CST) and whether this marker was associated with impaired stroke recovery. Retrospective clinical MRI scans were obtained from a cohort of participants enrolled in a natural history study with acute anterior circulation ischemic stroke and unilateral arm impairment (NIH Stroke Scale [NIHSS] arm motor item score ≥2). Maps of the change in fractional anisotropy (delta FA) and the DTBM log of the Jacobian (LnJ, representing volumetric change) between scans, acquired <36 hours and 30 days after stroke, were computed. Voxel-wise Spearman rank-based analysis identified clustered regions of interest (ROIs) where the delta FA and LnJ from baseline to 30 days correlated with individual arm motor recovery scores on the NIHSS from baseline to 30 days. Qualitative comparisons were made between delta FA and LnJ maps for good and poor recovery groups (delta NIHSS arm item score ≥2 or <2, respectively) in reference to controls. Twenty-one participants with anterior circulation stroke were evaluated (mean age 63.6 years, median NIHSS arm motor item score 4, 48% female). Voxel-wise statistical maps identified 2 ROIs for delta FA and 4 ROIs for LnJ showing strong correlations with arm motor recovery (range of Spearman ρ = 0.77-0.81, all p < 0.01). The delta FA ROIs included the corona radiata and adjacent white matter, whereas LnJ ROIs included the centrum semiovale, corona radiata, internal capsule, and pons. Visual inspection of the average delta FA map from participants with poor arm motor recovery showed diffuse changes in the CST and adjacent subcortical regions while LnJ maps demonstrated more focal CST changes, particularly in the brainstem and internal capsule. DTBM detects focal volume loss in the CST over the first 30 days after stroke likely related to Wallerian degeneration. These volumetric changes may provide complementary information to FA in characterizing white matter loss after stroke. Like FA, DTBM shows strong correlations with arm motor recovery that could be useful for predicting recovery after stroke.