White Matter Microstructural Injury in Patients With Acute Single Subcortical Infarction: A Preliminary Tract-Based Spatial Statistics With Atlas-Based Analysis.

BACKGROUND

Acute single subcortical infarction (ASSI) is a prevalent cerebrovascular disorder in clinical practice. Although progress has been made in understanding its central mechanisms, the patterns of white matter (WM) microstructural damage in early-stage unilateral lesions remain poorly characterized.

OBJECTIVE

This study aimed to examine WM microstructural alterations in ASSI patients using Tract-Based Spatial Statistics (TBSS) and Atlas-Based Analysis (ABA), and to assess the clinical utility of this combined approach.

METHODS

This prospective study enrolled 44 participants (20 patients with ASSI and 24 healthy control [HC] group). WM microstructure was evaluated using fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). TBSS was employed for voxel-wise analysis of the WM skeleton, while ABA was used to extract regions of interest (ROIs). Correlation analyses assessed associations between microstructural changes and Fugl-Meyer Assessment (FMA) scores.

RESULTS

Relative to the HC group, patients with ASSI showed significantly reduced FA in multiple bilateral WM tracts (p < 0.05), including bilaterally in the corticospinal tract (CST), cingulate gyrus, hippocampus, and inferior fronto-occipital fasciculus, as well as the right inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus, right superior longitudinal fasciculus (temporal part), and forceps major. ASSI patients also showed higher MD in several major WM tracts (p < 0.05), involving bilaterally in the anterior thalamic radiation and hippocampus, as well as the right CST, right cingulate gyrus, forceps major, right inferior fronto-occipital fasciculus, right ILF, right superior longitudinal fasciculus, and right superior longitudinal fasciculus (temporal part). The changes in AD and RD values were not statistically significant. FMA scores are closely correlated with the MD and FA of the right cingulate gyrus. The MD of the right hippocampus and right ILF is also associated with FMA scores (p < 0.05).

CONCLUSION

The combined TBSS-ABA approach provides a reliable means to evaluate WM damage in ASSI. It not only identifies lesion clusters but also precisely localizes impaired WM regions, facilitating motor dysfunction assessment.

TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2400085342.