弥散张量成像动态观察脑出血及脑梗死引起锥体束继发损伤  

MR Diffusion Tensor Imaging Dynamic Observation of Secondary Damage of Pyramidal Tract after Cerebral Hemorrhage and Cerebral Infarction

作　　者：李捷[1,2] 王大明[2] 胡浩宇[2] 孔江明[1] 董芳宏[1] 

机构地区：[1]浙江中医药大学附属金华中医院磁共振室,浙江金华321017 [2]浙江中医药大学附属金华中医院神经内科,浙江金华321017

出　　处：《实用放射学杂志》2011年第4期483-486,563,共5页Journal of Practical Radiology

摘　　要：目的 研究弥散张量成像动态观察脑出血及脑梗死引起的脑干相应锥体束继发损伤.方法 经临床及MRI证实的与皮质脊髓束相连的脑功能区的脑出血16例及脑梗塞12例,测量发病后3、15、30 d锥体束通过大脑脚、脑桥、延髓部位的部分各向异性（FA）值以及采用美国国立卫生研究院卒中量表（NIH stroke scale,NIHSS ）和改良 Rankin 量表（modified Rankin scale,MRS）评定患者神经功能缺失和日常生活能力的状况.结果 发病后3、15、30 d脑出血组和脑梗死组病侧的大脑脚、桥脑、延髓纤维束区FA值逐渐下降.延髓FA值的变化在各个时间点梗死组与出血组差别具有统计学意义（P＜0.05）.NIHSS和MRS结果 显示,患者的神经功能和生活能力都在恢复,但出血组恢复情况好于梗死组.结论 脑出血及脑梗死引起脑干相应锥体束通过区FA值的下降,可能与锥体束的髓鞘裂解和脱髓鞘改变导致华勒变性有关,DTI动态成像可用于观察病灶远隔区纤维束的华勒氏变性.Objective To study dynamic observation of secondary damage of pyramidal tract after cerebral hemorrhage and cerebral infarction with MR diffusion tensor imaging. Methods 16 cases with spontaneous intracerebral hemorrhage and 16 cases with cerebral infarction involving in corticospinal tracts confirmed by clinical and MR imaging were involved in this study. Fractional ani- sotropy （FA） values in cerebral peduncle, pons and medulla at day 3,15,30 after occurrence were measured. The patient＇s loss of nerve function and activity of daily living were evaluated according to the NIH stroke scale（NIHSS） and modified Rankin scale （MRS）. Results The FA values in cerebral peduncle, pons and medulla at day 3, 15 and 30 were gradually decreased in both cere- bral hemorrhage and cerebral infarction group. The changes of FA value in medulla were of statistical significances（P〈0.05） between cerebral hemorrhage group and cerebral infarction group at all time point. The results of NIHSS and MRS suggested that the recovery of nerve function and activity of daily living. However, the extent of recovery in cerebral hemorrhage group was superior to cerebral infarction group. Conclusion Cerebral hemorrhage and cerebral infarction can result in the decrease of FA value of pyramidal tract, which maybe related to the Wallerain degeneration resulting from split of medulla sheath and demyelination pyramidal tract. MR dynamic diffusion tensor imaging can observe this change in remote fasciculus.

关 键 词：脑 弥散张量成像 脑出血 脑梗死 锥体束损伤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.34[医药卫生—诊断学]