应用扩散张量成像研究脑梗死后早期皮质脊髓束Waller变性与运动功能的相关性  

Evaluation of the Relationship between Neuromotor Outcome and Early Wallerian Degeneration of Corticospinal Tract after Cerebral Infarction Using Diffusion Tensor MR Imaging

作　　者：方珉[1] 谢瑞满[2] 周林江[3] 李克[3] 

机构地区：[1]复旦大学附属第五人民医院神经内科 [2]复旦大学附属中山医院神经内科 [3]复旦大学附属华山医院放射科

出　　处：《中国医学计算机成像杂志》2011年第3期193-196,共4页Chinese Computed Medical Imaging

基　　金：复旦大学医学院青年骨干基金(2006-15)~~

摘　　要：目的:应用弥散张量成像(DTI)研究脑梗死后早期皮质脊髓束(CST)Waller变性与神经运动功能缺损的相关性。方法:起病至DTI检查时间在14d内的单侧大脑中动脉区脑梗死患者16例纳入研究,按间隔时间分为两组:组一,间隔3～7d;组二,间隔8～14d。通过放置感兴趣区(ROI)的方式获得CST各向异性分数(FA)值和平均扩散系数(MD)值,并计算出rFA和r MD。所有患者于DTI检查前2h及发病后3个月分别进行美国国立卫生研究院脑卒中评分(NI HSS)、运动功能指数(MI)和修正的Rankin评分(mRS)。结果:与健侧相比,病侧CST在第1周未见有明显的FA值与MD值的改变(t=-1.759,P=0.12;t=-1.475,P=0.18),而第2周FA值下降具有显著性差异(t=-3.725,P=0.007),但MD值变化不明显(t=-1.891,P=0.10)。脑梗死第2周的rFA与DTI检查时的NI HSS和MI无相关性,而与梗死后3个月的NI HSS和mRS呈负相关(r=-0.756,P=0.030;r=-0.741,P=0.035),与MI呈正相关(r=0.731,P=0.040)。结论:脑梗死第2周CST的FA值变化有助于预测梗死3个月后运动功能受损的恢复情况。Purpose： To evaluate the relationship between neuromotor outcome and early Wallerian degeneration of cortieospinal tract（CST） after cerebral infarction using diffusion tensor MR imaging（DTI） Methods： A total of 16 patients with middle cerebral artery infarction within 14 days after attack were studied with DTI. Quantitative FA and MD, obtained by placing regions of interest （ROI） at the ipsilat- eral cerebral peduncle, upper and lower slices of the pons, were compared with matched contralateral regions. The neurological examinations, together with NIHSS, MI and mRS were performed in all cases at the time of DTI and 3 months after cerebral infarction. Results： There was no significant difference in the DTI indices between the affected and unaffected sides at 1 week after cerebral infarction. And there was significant difference in the FA but not the MD at the 2 weeks after cerebral infarction. There were no significant correlations between the rFA of the CSTs and the NIHSS, MI at the second week after cerebral infarction. There were significant negative correlations between the rFA of the CSTs and the NIHSS, mRS and there were significant positive correlation between the rFA of the CSTs and the MI at the 3 months after cerebral infarction. Conclusion： The longterm neuromotor outcome could be predicted by the changes of FA at the second week after infarction attack.

关 键 词：脑梗死 皮质脊髓束 WALLER变性 扩散张量成像 各向异性分数 平均扩散系数 神经运动功能 

分 类 号：R445.2[医药卫生—影像医学与核医学]