Interhemispheric cerebral blood flow balance during recovery of motor hand function after ischemic stroke--a longitudinal MRI study using arterial spin labeling perfusion

• Published in: PloS one Vol. 9; no. 9; p. e106327
• Main Authors: Wiest, Roland, Abela, Eugenio, Missimer, John, Schroth, Gerhard, Hess, Christian W, Sturzenegger, Matthias, Wang, Danny J J, Weder, Bruno, Federspiel, Andrea
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.09.2014; Public Library of Science (PLoS)
• Subjects: Adult; Age; Aged; Aphasia; Biology and Life Sciences; Blood; Blood flow; Brain - pathology; Brain research; Cerebral blood flow; Cerebral hemispheres; Cerebrovascular Circulation; Cortex (cingulate); Cortex (motor); Cortex (parietal); Cross-Sectional Studies; Data acquisition; Data recovery; Dextrous hands; Female; Flow velocity; Functional Laterality; Grasping; Grip force; Hand; Hand - physiopathology; Humans; Ischemia; Labeling; Labelling; Longitudinal Studies; Magnetic Resonance Imaging; Male; Manual dexterity; Medical imaging; Medicine and Health Sciences; Middle Aged; Motor Activity; Neurology; Patients; Perfusion; Prospective Studies; Psychomotor Performance; Recovery of Function; Regional Blood Flow; Sensorimotor system; Spin labeling; Stroke; Stroke - pathology; Stroke - physiopathology; Studies; Supplementary motor area; Los Angeles California; California; United States > US; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0106327

Unilateral ischemic stroke disrupts the well balanced interactions within bilateral cortical networks. Restitution of interhemispheric balance is thought to contribute to post-stroke recovery. Longitudinal measurements of cerebral blood flow (CBF) changes might act as surrogate marker for this process. To quantify longitudinal CBF changes using arterial spin labeling MRI (ASL) and interhemispheric balance within the cortical sensorimotor network and to assess their relationship with motor hand function recovery. Longitudinal CBF data were acquired in 23 patients at 3 and 9 months after cortical sensorimotor stroke and in 20 healthy controls using pulsed ASL. Recovery of grip force and manual dexterity was assessed with tasks requiring power and precision grips. Voxel-based analysis was performed to identify areas of significant CBF change. Region-of-interest analyses were used to quantify the interhemispheric balance across nodes of the cortical sensorimotor network. Dexterity was more affected, and recovered at a slower pace than grip force. In patients with successful recovery of dexterous hand function, CBF decreased over time in the contralesional supplementary motor area, paralimbic anterior cingulate cortex and superior precuneus, and interhemispheric balance returned to healthy control levels. In contrast, patients with poor recovery presented with sustained hypoperfusion in the sensorimotor cortices encompassing the ischemic tissue, and CBF remained lateralized to the contralesional hemisphere. Sustained perfusion imbalance within the cortical sensorimotor network, as measured with task-unrelated ASL, is associated with poor recovery of dexterous hand function after stroke. CBF at rest might be used to monitor recovery and gain prognostic information.