Cited by 438Advanced Neuroimaging Techniques and ApplicationsAcute Ischemic Stroke ManagementStroke Rehabilitation and Recovery

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Diffusion tensor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke

Thomalla, Götz, Glauche, Volkmar, Koch, Martin A, Beaulieu, Christian, Weiller, Cornelius, Röther, Joachim·2004·NeuroImage

DOI 10.1016/j.neuroimage.2004.03.041

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Abstract

We used diffusion tensor imaging (DTI) to assess Wallerian degeneration of the pyramidal tract within the first 2 weeks after ischemic stroke, and correlated the extent of Wallerian degeneration with the motor deficit. Nine patients with middle cerebral artery stroke were examined 2-16 days after stroke by DTI and T2-weighted MRI. We measured fractional anisotropy (FA), averaged diffusivity (Dav), eigenvalues of the diffusion tensor and T2-weighted signal in the cerebral peduncle and compared these values between the affected and the unaffected side and between patients and six controls. FA was significantly reduced on the affected side compared to the unaffected side and compared to the control group. The largest eigenvalue was reduced, whereas the smallest eigenvalue was elevated on the affected side. There was no significant difference in T2-weighted signal and Dav. The decrease of anisotropy correlated positively with the motor deficit at the time of DTI study and 90 days after stroke. The reduction of anisotropy mirrors the disintegration of axonal structures, as it occurs in the early phase of Wallerian degeneration. DTI detects changes of water diffusion related to beginning pyramidal tract degeneration within the first 2 weeks after stroke that are not yet visible in conventional T2-weighted or orientationally averaged diffusion weighted MRI. We demonstrated for the first time a correlation of early DTI findings of pyramidal tract damage with the motor deficit. DTI can help prognosing recovery of motor function after stroke within the early subacute phase.

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“In the previous DTI studies, reduced FA and preserved MD resulted from both a reduced parallel diffusion and an increased perpendicular diffusion by accumulation of cellular debris from the breakdown of axons and glial proliferation [24–26].”
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BackgroundMethod
Apparent Diffusion Coefficient, Fractional Anisotropy and T2 Relaxation Time Measurement
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“Among the possible mechanisms, Wallerian degeneration is probably the main mechanism at play (as reported in the CST) (31, 39, 40).”
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Background
Prediction of motor outcome in ischemic stroke involving the pyramidal tract using diffusion tensor imaging
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BackgroundMethod
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“leading to an outflow of water into the expanded extracellular space leading to increased ADC and lower FA values.(8,14,27,32,33,34) Thus, CSM patients with imaging evidence of compression who present with higher FA and lower ADC values have acute compression may be more likely to recover with surgery than patients wi…”
Background
Anatomía de la sustancia blanca mediante tractografía por tensor de difusión
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“DTI is increasingly demonstrating greater accuracy in detecting microstructural damage related to Wallerian degeneration after acute stroke [19,20].”
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Method
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Background
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The Central Nervous System
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“Both indices provide subtler pathologic information (i.e., axonal vs. myelin injury) than do other scalar DTI parameters, such as FA and MD (Kumar et al., 2011; van der Eerden et al., 2014).”
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“Several studies showed degenerated intracranial CST within 3 months after onset in stroke patients by diffusion tensor imaging (DTI) or pathological examination(Buss et al., 2004; Matsusue et al., 2007; Puig et al., 2010; Thomalla et al., 2004).”
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“It is noted that large myelin axons, which are abundant in neuroﬁlaments, are susceptible to Waller’s degeneration following a stroke [25] .”
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“As diffusion anisotropy mirrors the fiber integrity and the degree of the fiber organization in the white matter tract [22], Pierpaoli and his colleagues [23] added that”
Background
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“In contrast, CST degeneration is likely the consequence of Wallerian degeneration due to direct fiber injury.(8,36)”
BackgroundMethodResultSelf-citation
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Li, S.-Y., Zhao, X. W., Cheng, M., Lü, L., Guo, J., Xuan, D., Sun, Y., Xing, Q., Meng, L., Liao, J.-J., et al. (2023) · Journal of Computer Assisted Tomography · doi:10.1097/rct.0000000000001507 · Cited by 4
“18,19 20 – 22 Some DTI studies have shown a general reduction in FAvalues of white matter fiber tracts in the brain of adult ASD patients.”
Background
T2/FLAIR mismatch and diffusion restriction as novel pathophysiological markers in MRI evaluation of central tegmental tract hyperintensity in pediatric patients
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USE OF MRI TO STUDY EXCITOTOXIC SPINAL CORD INJURY
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MR Imaging of White Matter Changes
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“A decrease of the fractional anisotropy indicates disintegration of axonal structuresand myelin (Thomalla et al. 2004).”
Background
Tracking the dynamics of secondary degeneration after stroke
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[Application of magnetic resonance diffusion tensor imaging in bilirubin-induced neurological dysfunction in neonates].
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Microstructure of the residual corticofugal projection from primary motor cortex in chronic stroke
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Neuroimaging Advances in Stroke Rehabilitation
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Unmyelinated and Myelinated Axons Exhibit Differential Injury and Treatment Responses Following Traumatic Injury
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T2/Fluid Attenuation Inversion Recovery Hypointensity of Corticospinal Tracts due to Subacute Stage of Wallerian Degeneration
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Impact of the acquisition protocol on the sensitivity to demyelination and axonal loss of clinically feasible DWI techniques: a simulation study
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Magnetic Resonance Diffusion Tensor Imaging in Evaluating Transcranial Magnetic Stimulation Treatment for Acute Ischemic Stroke: A Retrospective Study
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Structural-functional brain connectivity underlying integrative sensorimotor function after stroke
Kalinosky, B. T. (2016) · e-Publications@Marquette (Marquette University) · Cited by 2
Loss of Sarm1 Mitigates Axonal Degeneration and Promotes Neuronal Repair After Ischemic StrokePreprint
Wang, J. T., An, J., Toh, B., Yousefpour, K., Komuro, Y., Godoy, M. I., Putman, J. N., Carmichael, S. T., Damoiseaux, R. D., & Hinman, J. D. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.02.20.639171 · Cited by 2
“Similar morphologic changes in the white matter are also observed radiographically via diffusion tensor imaging in stroke patients (12, 13, 14, 15, 16).”
Brain plasticity and upper limb function after stroke : some implications for rehabilitation.
Lindberg, P. G. (2007) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 2
Observing the time course of early long pyramidal tract Wallerian degeneration after acute ischemic stroke: a case report
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Comparison of post-stroke white matter assessment using disconnectome-symptom mapping versus quantitative diffusion MRI
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Association of Corticospinal Tract Asymmetry With Ambulatory Ability After Intracerebral Hemorrhage
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Diffusion tensor imaging change in crus cerebri in striatocapsular infarction and correlation with upper extremity motor dysfunction
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“[7] carried out DTI scanning for 9 patients with acute supratentorial cerebral infarction 2–16 days after disease onset, and observed diffusion change of the pyramidal tract in the ipsilateral crus cerebri within 2 weeks after Fig.”
BackgroundMethodResult
Lack of the cerebral peduncle involvement in a series of adult supratentorial AVM: A diffusion tensor imaging study
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Possible Protective Effect of Regulatory T cells on White Matter Microstructural Abnormalities in Stroke Patients
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“Therefore, our finding of the reduced FA was a result not of demyelination but of a gross reduction in axonal number and/or size, possibly reflecting Wallerian degeneration secondary to neuronal loss due to stroke [13].”
Background
Assessing the Structural Footprint of Minimally Invasive Brain Cannulation on Cerebral White Matter: A Cadaveric Model
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Diffusion tensor imaging (DTI) studies of cerebral white matter integrity in normal to moderate cardiovascular risk patients
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Demyelinating and Degenerative Disease
(2009) · Springer eBooks · doi:10.1007/978-3-540-78785-3_9 · Cited by 1
Diffusion tensor imaging in acute ischemic stroke: the role of anisotropy in determining the time of onset and predicting long-term motor outcome
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Corticospinal Tract Diffusion Tensor Imaging and Motor Function in Children following Perinatal Stroke
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Reply to “The usefulness of diffusion tensor tractography for estimating the state of corticobulbar tract in stroke patients”
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Augmenting Plasticity and Recovery from Stroke by Modulating the Extracellular Matrix of the Central Nervous System
Wiersma, A. M. (2017) · ERA: Education and Research Archive (University of Alberta) · doi:10.7939/r3v698s16 · Cited by 1
Robust diffusion parametric mapping of motion-corrupted data with a three-dimensional convolutional neural networkPreprint
Gong, T., Tong, Q., He, H., Li, Z., & Zhong, J. (2019) · arXiv (Cornell University) · doi:10.48550/arxiv.1905.13075 · Cited by 1
“development and aging studies [Qiu et al., 2015; Yoshida et al., 2013] , and also to characterize neural tissue abnormalities in a variety of neurological and psychiatric disorders, including stoke [Thomalla et al., 2004], brain tumors [Inoue et al., 2005], neurodegenerative diseases [Cochrane and Ebmeier, 2013; Ingle…”
Background
Reduced microstructural white matter integrity in a genetic metabolic disorder: A diffusion tensor MRI study
Bava, S. (2007) · eScholarship (California Digital Library) · Cited by 1
Goal-Oriented Attentional Self-Regulation Training in Chronic Mild Traumatic Brain Injury Leads to Microstructural Plasticity in Prefrontal White MatterPreprint
Karbasforoushan, H., Wren-Jarvis, J., Hwang, A., Santiago, R., Raptentsetsang, S. T., Cai, L. T., Xiao, J., Maruyama, B. A., Abrams, G., Novakovic-Agopian, T., et al. (2023) · medRxiv · doi:10.1101/2023.09.29.23296363 · Cited by 1
MRI analysis of brain connectivity in a mouse model of Alzheimer’s disease
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Anatomo-functional magnetic resonance imaging of the spinal cord and its application to the characterization of spinal lesions in cats
Cohen‐Adad, J. (2008) · doi:10.71781/32272
Magnetic resonance diffusion tensor imaging in stroke
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Intracerebral Imaging and Carotid Artery Stenosis
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“This provides with images that can be fusioned to either obtain anisotropy images or even images of tractography [ 59 ], [22], [52], [16] (Figs.”
Method
Aging, implicit sequence learning, and white matter integrity
Bennett, I. J. (2009) · DigitalGeorgetown (Georgetown University Library)
Longitudinal three‐dimensional‐T2WI‐SPACE study on wallerian degeneration in cat corticospinal tract and underlying pathology changes
Zhang, M., Qin, W., Piao, Y., Guo, D., Zhu, Z., Tian, X., Li, K., & Yu, C. (2015) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.24876
“However, consensus had been reached by previous studies that two-dimensional (2D) T2W-TSE failed to detect WD at an early stage.(12) Only a few studies found low T2 signals at affected tract approximately 4 to 14 weeks after injury.”
Result
Answering the Call: The Influence of Neuroimaging and Electrophysiological Evidence on
Boyd, R. A., Vidoni, E. D., & Daly, J. J. (2007)
ORIGINAL RESEARCH Individual Detection of Patients with Parkinson Disease using Support Vector Machine Analysis of Diffusion Tensor Imaging Data: Initial Results
Haller, S., Badoud, S., Nguyen, D. D., & Garibotto, V. (2012)
The Clinical Applicability of fMRI and DTI in Patients with Brain Tumors
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Bildgebung beim Schlaganfall ± eine Übersicht und Empfehlungen des Kompetenznetzes Schlaganfall Imaging in Stroke ± An Overview and Recommendations from the German Competence Network Stroke
Thomalla, G., Audebert, H. J., Berger, K., et al. (2009)
Self-citation
Diffusion Tensor Imaging for the Differentiation of Microangiopathy, Infarction and Perfusion-Diffusion Mismatch Lesions
Ha, D. H., Choi, S.-S., Kang, M. J., et al. (2009) · Journal of the Korean Society of Radiology · doi:10.3348/jksr.2009.61.4.201
“96) was not different as compared to that of the normal brain (19).”
BackgroundInfluential

Authors: Thomalla, G., Glauche, V., Koch, M. A., Beaulieu, C., Weiller, C., & Röther, J.
Affiliations: University Medical Center Hamburg-Eppendorf (DE)
University of Alberta (CA)
Corresponding author: Thomalla, Götz
ORCID: Thomalla, Götz
Glauche, Volkmar
Koch, Martin A
Beaulieu, Christian
Weiller, Cornelius
Röther, Joachim
Venue: NeuroImage
Publisher: Elsevier BV
Published: 2004-08
Volume: 22
Issue: 4
Pages: 1767-1774
ISSN: 1053-8119 (ISSN-L)
DOI: 10.1016/j.neuroimage.2004.03.041
OpenAlex: W2059177186
Cited by: 438
References: 46
Citations by year: 2026: 9 · 2025: 10 · 2024: 13 · 2023: 15 · 2022: 12 · 2021: 24 · 2020: 15 · 2019: 17 · 2018: 15 · 2017: 16 · 2016: 23 · 2015: 18 · 2014: 33 · 2013: 25 · 2012: 21
FWCI: 18.44
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: NeuroImage (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Keywords: Wallerian degeneration, corticospinal tract, ischemic stroke, middle cerebral artery stroke, diffusion tensor imaging, fractional anisotropy, motor impairment, cerebral peduncle
MeSH terms: Aged, Axons, Dominance, Cerebral, Female, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Movement Disorders, Neurologic Examination, Prognosis, Pyramidal Tracts, Reference Values, Statistics as Topic, Wallerian Degeneration, Anisotropy, Infarction, Middle Cerebral Artery, Diffusion Magnetic Resonance Imaging

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Diffusion tensor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke

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