磁共振扩散张量成像评价脑梗死患者运动功能预后的价值  

The predictive value of diffusion tensor imaging in the evaluation of motor function recovery in patients with cerebral infarction

作　　者：郑莎莎[1] 张苗[1] 卢洁[1] 李坤成[1] 戎冬冬[1] 赵志莲[1] 曹燕翔[1] 赵澄[1] 马青峰[2] 

机构地区：[1]首都医科大学宣武医院医学影像学部放射科,北京100053 [2]首都医科大学宣武医院神经内科,北京100053

出　　处：《中华老年心脑血管病杂志》2011年第8期675-678,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科技新星项目资助(2009B047);北京市卫生局十百千项目资助(2009-31)

摘　　要：目的应用磁共振扩散张量成像(DTI)研究脑梗死不同时期扩散张量的变化规律,探讨脑梗死区的扩散张量及皮质脊髓束受累程度与患者临床预后的关系。方法选择内囊周围区脑梗死患者20例,分别于发病<7 d,1 5d.1、3、6个月进行5次DTI检查,测量各个时期脑梗死区相对部分各向异性分数值(rFA),应用Fugl-Meyer量表评价患者的运动功能,并应用扩散张量纤维束成像(DTT)技术进行皮质脊髓束三维重建。分析脑梗死区rFA及皮质脊髓束受累程度与患者运动功能恢复的关系。结果 20例患者发病后1个月内,梗死灶rFA持续降低,3个月后开始缓慢上升,但始终低于发病早期(<7 d)病灶的rFA(F=6.410,P=0.000);与发病7 d内比较,1、3个月时梗死灶rFA的降低程度与患者Fugl-Meyer量表评分呈负相关(r=-0.503,P<0.05;r=-0.517,P<0.05)。DTT显示,皮质脊髓束中断、移位、纡曲等改变,皮质脊髓束的受累程度与脑梗死后3个月Fugl-Meyer量表评分预后呈负相关(r=-0.71 6,P<0.05)。结论脑梗死区rFA随病程呈动态变化;rFA的降低程度及皮质脊髓束受累程度均与患者运动功能恢复有关,可为早期评价脑梗死的预后提供重要依据。Objective To explore the evolution of diffusion tensor characteristics in different stages of cerebral infarction and the relationship of diffusion tensor in cerebral infarct area and corticospinal tract injury with clinical prognosis. Methods Twenty patients with pericapsular infarction underwent five DTI examinations within 7 days, 15 days, 1 month, 3 months and 6 months after stroke symptom onset. Motor function was assessed with Fugl-Meyer scores. Three-dimensional reconstructions of corticospinal tract were performed using DTT. The changes of relative fractional anisotropy（rFA） values in the infarcted areas at different time points and their relation to motor function recovery were studied. The relationship between corticospinal tract injury and motor function recovery was analyzed. Results The rFA values declined continuously within 1 month after infarction and rose slowly after 3 months. The decrease in rFA values in 1 month and 3 months showed a negative correlation with Fugl-Meyer Score. DTT showed the changes of corticospinal tract including disruption, displacement and tortuosity. The involvement of the corticospinal tract was negatively correlated with Fugl-Meyer Score. Conelusions rFA values in infarcted areas evolve dynamically. The decrease in rFA values and the extent of corticospinal tract injury can greatly help the evaluation of clinical prognosis.

关 键 词：脑梗死 磁共振成像 弥散 运动障碍 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]