磁共振DTI及DTT在脑梗死白质纤维束损伤中的应用  

MR Diffusion Tensor Imaging and Diffusion Tensor Tractography in White Matter Fiber Bundle Injury Following Cerebral Infarction

作　　者：王海滨[1] 陈文辉[1] 乔松[2] 许琦[3] 赵国库[4] 

机构地区：[1]杭州市第一人民医院放射科,杭州310006 [2]浙江省浙江医院神经内科,杭州310013 [3]浙江省浙江医院放射科,杭州310013 [4]吉林大学第一医院放射科,吉林130021

出　　处：《放射学实践》2010年第3期267-270,共4页Radiologic Practice

摘　　要：目的:探讨MR扩散张量成像(DTI)及扩散张量纤维束成像(DTT)技术对不同时期脑梗死白质损伤的诊断价值,并观察白质纤维束的受损情况,为脑梗死后患侧肌力恢复治疗提供影像学依据。方法:53例脑梗死患者按不同发病时期分为4组,行常规MRI及DTI检查,对比测量梗死侧与健侧相应部位脑白质的各向异性系数(FA)值,并观察梗死灶白质纤维束的改变,按照皮质脊髓束(CST)移位、连续性及破坏程度在DTT图像上的表现分为3级。结果:超急性期梗死侧FA值(0.35±0.04)与健侧(0.37±0.06)比较差异无统计学意义(P>0.05),急性期、亚急性期和慢性期梗死侧FA值分别为0.17±0.07、0.14±0.06和0.09±0.05,分别低于健侧相应部位的FA值(分别为0.39±0.08、0.36±0.08和0.33±0.06),差异均有显著性意义(P<0.05)。3组DTT分级比较差异无统计学意义(P>0.05),患侧肌力改变与皮质脊髓束损伤程度呈正相关(rs=0.76,P<0.05),皮质脊髓束损伤程度可以通过重建的扩散张量纤维束成像显示。结论:DTI及DTT技术能较好的评价不同时期脑梗死白质纤维束的损伤程度,对指导临床诊断和帮助判断预后有重要价值。Objective：To investigate the value of diffusion tensor imaging （DTI） and diffusion tensor tractography （DTT） techniques in the diagnosis of different stages of white matter injury following cerebral infarction, and to evaluate the injured conditions of white matter fiber bundles, in order to provide imaging evidence of muscle strength recovery in the affected side after treatment. Methods：Fifty-three patients with cerebral infarction were divided into 4 groups according to the stages of onset, conventional magnetic resonance imaging （MRI） and DTI techniques were performed routinely. The fractional anisotropy （FA） values of white matter in infarct side and contralateral side were measured and compared. The changes of white matter fiber bundle were evaluated and classified into three grades according to shifting, continuity and destruction extent of corticospinal tract （CST） manifesting in DTT images. Results： No significant statistical difference was existed in the FA values of infarct side （0.35±0.04） and contralateral （0.37±0.06） in super-acute stage （P〉0.05）. In acute stage, sub-acute stage and chronic stage, the FA values of infarct side were 0.17 ± 0.07,0.14 ± 0.06,0.09 ± 0.05, respectively, which were lower than that in the contralateral corresponding regions： 0.39 ± 0.08,0.36 ± 0.08,0.33 ±0.06, respectively,all had significant differences （P〈0. 05）. There was no statistical difference of FA values in the three groups classified by DTT grading （P〈0.05）. The muscle strength of infarct side had positive correlation with injury degree of CST （rs=0.76 ,P〈0.05） ,and injury degree of CST could be demonstrated by reconstituted DTT images. Conclusion： The injury degree of white matter fiber bundles in different stages of cerebral infarction could be well evaluated by DTI and DTT techniques, which is of important value in the guidance of clinical diagnosis and prediction of prognosis.

关 键 词：脑梗死 扩散张量成像 皮质脊髓束 脑白质纤维束成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]