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Resting interhemispheric functional magnetic resonance imaging connectivity predicts performance after stroke

Authors

  • Alex R. Carter MD, PhD,

    1. Department of Neurology, Washington University School of Medicine, St. Louis, MO
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    • A.R.C. performed the analysis of most imaging data (BOLD functional connectivity analysis and stroke lesion segmentation analysis), imaging-behavior correlations, and statistical analysis, assisted in the recruitment and scanning of subjects, and wrote the paper.

  • Serguei V. Astafiev PhD,

    1. Department of Radiology, Washington University School of Medicine, St. Louis, MO
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    • S.V.A. assisted in the scanning of subjects, image analysis, ROI creation, and encoding of behavioral data, and developed the composite functional connectivity scores.

  • Catherine E. Lang PhD,

    1. Department of Neurology, Washington University School of Medicine, St. Louis, MO
    2. Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
    3. Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
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    • C.E.L. contributed to the experimental design and development of an appropriate battery for testing motor behavior.

  • Lisa T. Connor PhD,

    1. Department of Neurology, Washington University School of Medicine, St. Louis, MO
    2. Department of Radiology, Washington University School of Medicine, St. Louis, MO
    3. Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
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    • L.T.C. contributed to the experimental design and behavioral battery and helped with the statistical analysis.

  • Jennifer Rengachary MSOT,

    1. Department of Neurology, Washington University School of Medicine, St. Louis, MO
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    • J.R. recruited and obtained consent from patients, assisted in the scanning, administered the behavioral battery, and analyzed the behavioral data.

  • Michael J. Strube PhD,

    1. Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
    2. Department of Psychology, Washington University in St. Louis, St. Louis, MO
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    • M.J.S. instructed the authors in statistical methods for comparing nonindependent correlations.

  • Daniel L. W. Pope BS,

    1. Department of Radiology, Washington University School of Medicine, St. Louis, MO
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    • D.L.W.P. assisted in scanning and behavioral testing.

  • Gordon L. Shulman PhD,

    1. Department of Neurology, Washington University School of Medicine, St. Louis, MO
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    • G.L.S. and M.C. designed the study, oversaw data acquisition and analysis, and were principal editors of the paper. All authors discussed the results and commented on the paper.

  • Maurizio Corbetta MD

    Corresponding author
    1. Department of Neurology, Washington University School of Medicine, St. Louis, MO
    2. Department of Radiology, Washington University School of Medicine, St. Louis, MO
    3. Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO
    • Departments of Neurology, Radiology, and Anatomy and Neurobiology, Washington University, Box 8111, 4525 Scott Ave, Saint Louis, MO 63110
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    • G.L.S. and M.C. designed the study, oversaw data acquisition and analysis, and were principal editors of the paper. All authors discussed the results and commented on the paper.


Abstract

Objective

Focal brain lesions can have important remote effects on the function of distant brain regions. The resulting network dysfunction may contribute significantly to behavioral deficits observed after stroke. This study investigates the behavioral significance of changes in the coherence of spontaneous activity in distributed networks after stroke by measuring resting state functional connectivity (FC) using functional magnetic resonance imaging.

Methods

In acute stroke patients, we measured FC in a dorsal attention network and an arm somatomotor network, and determined the correlation of FC with performance obtained in a separate session on tests of attention and motor function. In particular, we compared the behavioral correlation with intrahemispheric FC to the behavioral correlation with interhemispheric FC.

Results

In the attention network, disruption of interhemispheric FC was significantly correlated with abnormal detection of visual stimuli (Pearson r with field effect = −0.624, p = 0.002). In the somatomotor network, disruption of interhemispheric FC was significantly correlated with upper extremity impairment (Pearson r with contralesional Action Research Arm Test = 0.527, p = 0.036). In contrast, intrahemispheric FC within the normal or damaged hemispheres was not correlated with performance in either network. Quantitative lesion analysis demonstrated that our results could not be explained by structural damage alone.

Interpretation

These results suggest that lesions cause state changes in the spontaneous functional architecture of the brain, and constrain behavioral output. Clinically, these results validate using FC for assessing the health of brain networks, with implications for prognosis and recovery from stroke, and underscore the importance of interhemispheric interactions. ANN NEUROL 2010;67:365–375

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