Cerebral blood flow asymmetry in motor-related regions is associated with 30-day upper-limb motor recovery after acute ischemic stroke
Abstract
BackgroundUpper-limb motor impairment is a leading cause of long-term disability after acute ischemic stroke (AIS), yet early prognostication relies mainly on clinical scales. Cerebral blood flow (CBF) asymmetry measured by arterial spin labeling (ASL) perfusion MRI may indicate recovery potential. We investigated whether acute-phase CBF asymmetry indices (AIs) in six motor-related regions are associated with 30-day upper-limb motor recovery.MethodsSixty patients with AIS underwent pseudo-continuous ASL MRI within 72 h of onset and completed the 30-day Fugl-Meyer Assessment of the Upper Extremity (FMA-UE). Patients were classified into good (n = 30, ΔFMA-UE ≥ 10) and poor (n = 30, ΔFMA-UE ≤ 4) recovery groups; both thresholds lie outside the published minimal clinically important difference range, and no patient fell between them. Mean CBF was extracted bilaterally from the precentral and postcentral gyri, supplementary motor area, putamen, pallidum, and thalamus, and AIs were calculated. Regional AI–ΔFMA-UE associations were assessed with Spearman correlation, partial correlation, analysis of covariance, and linear regression.ResultsPrecentral and postcentral gyrus AIs each correlated positively with ΔFMA-UE (both Spearman r = 0.30, p = 0.020; false-discovery-rate q = 0.020), persisting after adjustment for cognitive status, baseline FMA-UE, and lesion volume (partial r up to 0.326; all p < 0.05); other regional AIs showed negligible correlations (|r| < 0.09). In analysis of covariance (follow-up FMA-UE as outcome, baseline FMA-UE as covariate), precentral gyrus AI remained associated with the outcome (β = 0.13, 95% CI 0.01–0.25, p = 0.037; after cognitive adjustment, p = 0.045). A model combining the six AIs with age and cognitive status explained 29.7% of variance in ΔFMA-UE (F(8,51) = 2.69, p = 0.015), but adding the AIs to clinical variables alone did not significantly improve explanatory performance (ΔR2 = 0.048, p = 0.170); this R2 reflects the combined imaging–clinical model rather than ASL alone.ConclusionSensorimotor-cortex CBF asymmetry within 72 h of onset was associated with 30-day upper-limb motor recovery after AIS, robust to adjustment for clinical variables. Acute-phase ASL may serve as a noninvasive imaging indicator for recovery-oriented rehabilitation stratification, a hypothesis requiring further validation.
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BibTeX
@article{shi2026cerebral,
title = {{Cerebral blood flow asymmetry in motor-related regions is associated with 30-day upper-limb motor recovery after acute ischemic stroke}},
author = {Yongwei Shi and Yichen Lv and Shaoge Gao and Cancan Bi and Fangju Hu and Xi Zhu and Hongyu Zhou and Xin Wang},
journal = {Frontiers in Neuroscience},
year = {2026},
month = oct,
doi = {10.3389/fnins.2026.1955245},
url = {https://www.frontiersin.org/articles/10.3389/fnins.2026.1955245},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cerebral blood flow asymmetry in motor-related regions is associated with 30-day upper-limb motor recovery after acute ischemic stroke
AU - Yongwei Shi
AU - Yichen Lv
AU - Shaoge Gao
AU - Cancan Bi
AU - Fangju Hu
AU - Xi Zhu
AU - Hongyu Zhou
AU - Xin Wang
PY - 2026
DA - 2026/10/30
JO - Frontiers in Neuroscience
DO - 10.3389/fnins.2026.1955245
UR - https://www.frontiersin.org/articles/10.3389/fnins.2026.1955245
AB - BackgroundUpper-limb motor impairment is a leading cause of long-term disability after acute ischemic stroke (AIS), yet early prognostication relies mainly on clinical scales. Cerebral blood flow (CBF) asymmetry measured by arterial spin labeling (ASL) perfusion MRI may indicate recovery potential. We investigated whether acute-phase CBF asymmetry indices (AIs) in six motor-related regions are associated with 30-day upper-limb motor recovery.MethodsSixty patients with AIS underwent pseudo-continuous ASL MRI within 72 h of onset and completed the 30-day Fugl-Meyer Assessment of the Upper Extremity (FMA-UE). Patients were classified into good (n = 30, ΔFMA-UE ≥ 10) and poor (n = 30, ΔFMA-UE ≤ 4) recovery groups; both thresholds lie outside the published minimal clinically important difference range, and no patient fell between them. Mean CBF was extracted bilaterally from the precentral and postcentral gyri, supplementary motor area, putamen, pallidum, and thalamus, and AIs were calculated. Regional AI–ΔFMA-UE associations were assessed with Spearman correlation, partial correlation, analysis of covariance, and linear regression.ResultsPrecentral and postcentral gyrus AIs each correlated positively with ΔFMA-UE (both Spearman r = 0.30, p = 0.020; false-discovery-rate q = 0.020), persisting after adjustment for cognitive status, baseline FMA-UE, and lesion volume (partial r up to 0.326; all p < 0.05); other regional AIs showed negligible correlations (|r| < 0.09). In analysis of covariance (follow-up FMA-UE as outcome, baseline FMA-UE as covariate), precentral gyrus AI remained associated with the outcome (β = 0.13, 95% CI 0.01–0.25, p = 0.037; after cognitive adjustment, p = 0.045). A model combining the six AIs with age and cognitive status explained 29.7% of variance in ΔFMA-UE (F(8,51) = 2.69, p = 0.015), but adding the AIs to clinical variables alone did not significantly improve explanatory performance (ΔR2 = 0.048, p = 0.170); this R2 reflects the combined imaging–clinical model rather than ASL alone.ConclusionSensorimotor-cortex CBF asymmetry within 72 h of onset was associated with 30-day upper-limb motor recovery after AIS, robust to adjustment for clinical variables. Acute-phase ASL may serve as a noninvasive imaging indicator for recovery-oriented rehabilitation stratification, a hypothesis requiring further validation.
SN - 1662-453X
ER -