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A prospective study of MRI biomarkers in the brain and lower limb muscles for prediction of lower limb motor recovery following stroke

Lookup NU author(s): Dr Mat Elameer, Hannah LumleyORCiD, Sarah Moore, Abi Alton, Dr Fiona Smith, Dr Akif Gani, Professor Andrew BlamireORCiD, Emerita Professor Helen Rodgers, Dr Christopher Price, Dr Dipayan Mitra



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Copyright © 2023 Elameer, Lumley, Moore, Marshall, Alton, Smith, Gani, Blamire, Rodgers, Price and Mitra.The aim of this prospective observational longitudinal study was to explore and decipher the predictive value of prospective MRI biomarkers in the brain and lower limb muscles for 3-month lower limb motor recovery following stroke. In the brain, we measured the integrity of the corticospinal tract (fractional anisotropy/“FA”). In the muscles, we measured volume, fatty replacement (fat fraction analysis and proton spectroscopy) and oedema. Measurements were taken at two time points: (1) within 4 weeks of stroke (baseline measurement, clinical and imaging) and (2) 3 months following stroke (follow up measurement, clinical only). Clinical measurements consisted of assessments of functional ability and strength (Fugl-Meyer score, motor NIHSS, Functional Ambulation Category/“FAC”, and muscle dynamometry). Twenty-three patients completed imaging and clinical assessments at baseline and follow-up; five patients had partial imaging assessment. The results provided some evidence that damage to the corticospinal tract would result in less motor recovery: recovery of the Fugl-Meyer score and dynamometric ankle plantarflexion, ankle dorsiflexion, and knee extension correlated positively and significantly with fractional anisotropy (0.406–0.457; p = 0.034—p = 0.016). However, fractional anisotropy demonstrated a negative correlation with recovery of the Functional Ambulation Category (−0.359, p = 0.046). For the muscle imaging, significant inverse correlation was observed between vastus lateralis fat fraction vs. NIHSS recovery (−0.401, p = 0.04), and a strong positive correlation was observed between ratio of intra- to extra-myocellular lipid concentrations and the recovery of knee flexion (0.709, p = 0.007). This study supports previous literature indicating a positive correlation between the integrity of the corticospinal tract and motor recovery post-stroke, expanding the limited available literature describing this relationship specifically for the lower limb. However, recovery of functional ambulation behaved differently to other clinical recovery markers by demonstrating an inverse relationship with corticospinal tract integrity. The study also introduces some muscle imaging biomarkers as potentially valuable in the prediction of 3-month lower limb motor recovery following stroke.

Publication metadata

Author(s): Elameer M, Lumley H, Moore SA, Marshall K, Alton A, Smith FE, Gani A, Blamire A, Rodgers H, Price CIM, Mitra D

Publication type: Article

Publication status: Published

Journal: Frontiers in Neurology

Year: 2023

Volume: 14

Online publication date: 24/10/2023

Acceptance date: 26/09/2023

Date deposited: 21/11/2023

ISSN (electronic): 1664-2295

Publisher: Frontiers Media SA


DOI: 10.3389/fneur.2023.1229681


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Funder referenceFunder name
Newcastle Biomedical Research Council