Combined study of transcranial magnetic stimulation and diffusion tensor tractography for prediction of motor outcome in patients with corona radiata infarct.

OBJECTIVE This study compared the usefulness of transcranial magnetic stimulation (TMS), diffusion tensor tractography (DTT), and the combined study of TMS and DTT for prediction of motor outcome in patients with corona radiata infarct. METHODS Fifty-eight patients with complete motor weakness of the affected hand were recruited. TMS and DTT were performed in the early stage (7-28 days) of stroke. Patients were classified into 2 groups according to the presence of motor evoked potential in affected hand muscle, and according to the preservation of integrity of the affected corticospinal tract on DTT. RESULTS The specificity of TMS (0.93) was higher than that of DTT (0.48), and the sensitivity of DTT (0.86) was higher than that of TMS (0.66). There was a good outcome in 89.5% of patients with TMS (+) and DTT (+), which was similar to the patients (90.5%) with single TMS (+). In contrast, there was a poor outcome in 87.5% of patients with TMS (-) and DTT (-), which was higher than those with single TMS (-) (73.0%) or DTT (-) (77.8%). CONCLUSION TMS showed higher positive predictability and DTT showed higher negative predictability. The combined study of TMS and DTT appeared to be more advantageous in prediction of negative motor outcome than did each single study. Single TMS appeared to be more advantageous in prediction of positive motor outcome.