Imaging for Prediction of Functional Outcome and Assessment of Recovery in Ischemic Stroke

Stroke is a leading cause of long-term adult disability worldwide. Only a small proportion of stroke survivors (≈14%) achieve full recovery of activities of daily living, whereas 25% to 50% require some assistance and approximately half experience long-term dependency.1 Prediction of outcome after ischemic stroke, therefore, is important for setting realistic and attainable treatment goals, informing patients and their relatives properly, facilitating discharge planning, and anticipating possible consequences for home adjustments and community support.2 Moreover, knowledge of the expected recovery pattern is necessary to assess the effectiveness of new therapeutic interventions and their contribution to recovery and should be applied to select comparable patients populations for treatment trials.3Several standardized measures assess various aspects of stroke outcome and recovery, including quantification of neurological deficits, functional outcome measures, and quality of life measures. Activities of daily living, including dressing, mobility, and bathing, are assessed most frequently by the Barthel Index4 and by the modified Rankin Scale (mRS)5 but also by the Glasgow Outcome Scale,6 the Functional Independence Measure,7 or other activities of daily living assessment tools.8 Frequently used measures of quality of life include the Stroke Impact Scale and European Quality of Life Scale (EQ-5D).9,10 A considerable number of prognostic stroke studies used the Barthel Index and the mRS as the primary outcome measure reached after 3 to 6 months and found that scores on scales assessing severity of neurological deficits such as the National Institutes of Healt Stroke Scale (NIHSS)11–13 and Canadian Neurological Scale14 in acute stroke (ie, within 72 hours) are strongly associated with outcome beyond 3 months.2,15A systemic review of prognostic studies8 indicated that age and motor weakness were important predictive variables of outcome in addition to stroke …