Lesion network mapping for neurological deficit in acute ischemic stroke.

Objective To create a comprehensive map of strategic lesion network localizations for neurological deficits and identify prognostic neuroimaging biomarkers to facilitate the early detection of patients with a high risk of poor functional outcomes in acute ischemic stroke (AIS). Methods In a large-scale multicenter study of 7807 patients with AIS, we performed voxel-based lesion-symptom mapping (VLSM), functional disconnection mapping (FDC), and structural disconnection mapping (SDC) to identify distinct lesion and network localizations for National Institutes of Health Stroke Scale (NIHSS) score. Impact scores were calculated based on the odds ratios (ORs) or t-values of voxels from VLSM, FDC, and SDC results. Ordinal regression models were used to investigate the predictive value of the impact scores on functional outcome (defined as the Modified Rankin score at 3 months). Results We constructed lesion, FDC, and SDC maps for each item of the NIHSS score, which provided insights into the neuroanatomical substrate and network localization of neurological function deficits after AIS. The lesion impact score of limb ataxia, SDC impact score of limb deficit, and FDC impact score of sensation and dysarthria were significantly associated with mRS at 3 months. Adding SDC impact score, FDC impact score, and lesion impact score to NIHSS total score improved the performance in predicting functional outcomes, as compared to using NIHSS score alone. Interpretation We constructed comprehensive maps of strategic lesion network localizations for neurological deficits that were predictive of functional outcomes in AIS. These results may provide specifically localized targets for future neuromodulation therapies. This article is protected by copyright. All rights reserved.