磁共振弥散张量成像(DTI)在脑梗死皮质脊髓束损伤与运动功能转归相关性中的应用研究  

Study on the Application of DTI to the Relativity between Impairment of Corticospinal Tract and Motor Function Recovery after Cerebral Infarction

作　　者：刘树学[1] 王本国[1] 莫雪玲[1] 唐玉德[1] 王耿[1] 张雄彪[1] 洪云恒[1] 罗丽好[1] 陈志明[1] 李水连[1] 肖铮[1] 

机构地区：[1]广州中医药大学中山附属医院放射科,广东中山528400

出　　处：《中国CT和MRI杂志》2011年第5期28-31,共4页Chinese Journal of CT and MRI

基　　金：中山市科研基金立项(项目编号:20082A083)

摘　　要：目的利用磁共振弥散张量成像(DTI)研究脑梗死各向异性特征,结合扩散张量纤维束重建(DTT)评价脑梗死后皮质脊髓束损伤与运动功能转归的相关性。方法对10名正常成人志愿者及57名脑梗死患者进行常规磁共振成像及磁共振弥散张量成像,测量双侧大脑脚、内囊后肢、梗死灶及其对侧对称区域的部分各向异性系数(FA值),并进行比较分析;对双侧皮质脊髓束进行扩散张量纤维束重建(DTT),并分级;在DTI检查前及治疗后,对患者进行美国国立卫生研究院卒中评分(NIHSS)及简式Fugl-Meye运动功能评分(FMS),将脑梗死病灶区域FA值降低率与NIHSS及CST的DTT分级与治疗后运动功能评分(FMS)进行Pearson相关性分析。结果志愿者双侧大脑脚、内囊后肢及半卵圆中心平均FA值双侧对比均无统计学差异(P>0.05);脑梗死病例病灶区域平均FA值与对侧比较,无论急性期、亚急性期和慢性期病例均具有明显统计学意义(P<0.05),FA值降低率与NIHSS评分呈正相关(Pearson相关系数为0.500,p=0.001);脑梗死病例大脑脚及内囊后肢FA值与对侧比较,急性期病例无统计学意义(P>0.05),而亚急性期及慢性期病例均具有统计学意义(P<0.05);DTT显示CST纤维束分级与康复治疗后运动功能评分(FMS)呈负相关(Pearson相关系数为-0.899,p=0.000)。结论 DTI能较好的评价脑梗死后白质纤维束的损伤程度;皮质脊髓束的损害程度与患者的运动功能恢复具有明显相关性。Objective To study the characteristics of anisotropy of cerebral infarction by diffusion tensor imaging（DTI） and to evaluate the relativity between impairment of cortical spinal tract and motor recovery after cerebral infarction by diffusion tensor tractography（DTT）.Methods Conventional MRI and DTI were performed to ten healthy volunteers and fifty-seven patients with cerebral infarction.The fractional anisotropy（FA） values of bilateral cerebral peduncles,posterior limbs of internal capsule,infarction focus and its contralateral side were measured,compared and analyzed;Diffusion tensor tractogeaphy（DTT） were performed to the cortical spinal tract（CST）.The changes of CST were classified.Those patients were evaluated by the National Institutes of Health Stroke Scale（NIHSS） and the Fugl-Meyer Motor Scale（FMS） before DTI and after treatment.Pearson correlation analysis was performed to the FA reduction ratio of infarction focus,the DTT classification of CST,NIHSS and FMS after treatment.Results The average FA values of bilateral cerebral peduncles,posterior limbs of internal capsule and centrum semiovale of volunteers were not have statistical differences（P0.05）;the average FA values of infarction focus and its contralateral side had statistical differences,no mater in acute stage,subacute stage or chronic stage（P 0.05）,and the FA reduction ratio of infarction focus had positive correlation with the NIHSS（Pearson＇s correlation coefficient was 0.500,p=0.001）;the FA values of bilateral cerebral peduncles and posterior limbs of internal capsule of patients with cerebral infarction were not have statistic differences in acute stage（P0.05）,but had statistic differences in subacute stage and chronic stage（P0.05）.DTT showed that the grades of CST had negative correlation with FMS after treatment（Pearson＇s correlation coefficient was-0.899,p=0.000）.Conclusion The injury of white matter fiber bundles after cerebral infarction could be well evaluated by DTI;the motor func

关 键 词：弥散张量成像 脑梗死 皮质脊髓束 运动功能 

分 类 号：R445.2[医药卫生—影像医学与核医学] R54[医药卫生—诊断学]