应用DTI技术研究脑卒中患者运动康复中红核的结构可塑性  

Study on the Plastic Reorganization of the Red Nucleus during Motor Recovery of Ischemic Stroke Patients by Diffusion Tensor Imaging

作　　者：杨亚茹 杨明[2] 何慧[1] 杜芳[1] 

机构地区：[1]扬州大学附属医院,225000 [2]南京医科大学附属儿童医院,210000

出　　处：《临床放射学杂志》2020年第9期1710-1713,共4页Journal of Clinical Radiology

摘　　要：目的采用扩散张量成像(DTI),探讨慢性缺血性脑卒中后红核、中脑被盖的结构重塑与运动预后的关系。方法搜集慢性缺血性脑卒中患者53例,匹配健康志愿者20名(健康对照组)。采集DTI数据,重组双侧皮质脊髓束(CST)、辅助运动纤维束(aMF),并评估卒中组患侧与健侧CST、aMF、红核及中脑被盖的各向异性分数(FA)值,观察该值与Fugl-Meyer运动量表(FMA)的相关性。结果卒中组患侧CST、aMF的FA值明显低于健侧健康对照组(均P<0.05,CST患侧:0.34±0.24,aMF患侧:0.30±0.25);相较于健康对照组,卒中组双侧红核及患侧被盖的FA值均有所升高(均P<0.05,红核健侧:0.48±0.07;红核患侧:0.51±0.07;被盖患侧:0.55±0.06)。CST、aMF的FA值偏侧性指数(LI)、患侧红核、患侧被盖的FA值与上肢FMA、FMA总分呈显著线性相关(均P<0.05,r=-0.659,-0.667;r=-0.600,-0.598;r=0.420,0.410;r=0.450,0.470)。结论脑卒中后,红核及中脑被盖发生了一定程度的结构重塑,一些锥体外系对运动功能恢复发挥了一定的代偿作用。Objective To evaluate the relationship between the possible remodeling of red nucleus and the midbrain tegmentum and motor status in patients with chronic ischemic stroke using diffusion tensor imaging(DTI).Methods Fifty three patients with chronic ischemic stroke were recruited along with 20 matched normal controls.The DTI data was acquired and preprocessed.Bilateral descending motor tracts including corticospinal tract(CST)and alternate motor fibers(aMF)were constructed.The regional fractional anisotropy(FA)values of bilateral descending motor tracts,red nuclei and midbrain tegmentum were acquired and the relationships between FA value and FMA were assessed.Results The FA value of ipsilesional CST and aMF were lower in patient subgroups compared to that in contralesional and normal controls(P<0.05,CST:0.34±0.24,aMF:0.30±0.25),but clusters of higher FA were found Bilaterally in red nuclei and ipsilesional in midbrain tegmentum(P<0.05,red nucleus unaff:0.48±0.07;red nucleus aff:0.51±0.07;midbrain tegmentum aff:0.55±0.06).The laterality indices of regional FA value(CST,aMF)and FA along ipsilesional red nucleus,midbrain tegmentum correlated significantly with upper extremity FMA and total FMA(P<0.05,r=-0.659,-0.667;r=-0.600,-0.598;r=0.420,0.410;r=0.450,0.470).Conclusion Our results shed light on the role of extrapyramidal system,and highlight a compensatory function of the which may be used as a target in future restorative treatments.

关 键 词：卒中 扩散张量成像 红核 网状结构 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]