Waimei Tai, MD
Figueras J, et al.
Puig et. al recently published a paper suggesting to use the ratio of fractional anisotropy (rFA) in diffusion tensor imaging (DTI) to help predict long term prognosis after motor stroke. It suggests how this technology can help assess patients and provide better prognostic information at a 30 day scan, to predict long term eventual motor outcome at 2 years. The threshold values using area under the curve analysis suggest that rFA <0.982 for slight-moderate and rFA <0.689 for severe deficit are quite good suggesting that it may potentially have a good correlation with predicted outcome. The study was limited by a small number of patients who had limited or poor motor outcomes at 2 years.
I am not sure how I would use this information in current standard practice. I do think that providing prognostic information to patients earlier in the course is useful, as it may help guide decision making in adjustments and adaptations in lifestyle for various levels of disability, but I think this is quite limited and early data to suggest that it limit or offer more physical rehabilitation for patients who have either a very high rFA or low rFA value. I would still recommend further rehabilitation for all my patients who suffer from motor deficits, even at 30 days.
But perhaps this type of imaging information may be helpful in identifying patients who may benefit from neuro-recovery therapeutic trials, such as stem cell studies that are currently being proposed.
How do you think new forms of advancing imaging will play a role as we progress in our ability to further prognosticate in stroke care?