磁共振弥散张量纤维束成像对脑梗死患者预后评估的临床研究  

Clinical study of magnetic resonance diffusion tensor tractography on the evaluation of prognosis in patients with cerebral infarction

作　　者：赵静[1] 常文龙[2] 许云鹤[1] 赵小妹[1] 邢震宇[3] 刘永刚[1] 

机构地区：[1]河北省保定市第一中心医院神经内一科,071000 [2]河北省保定市第一中心医院内分泌实验室,071000 [3]河北省保定市第一中心医院心胸外科,071000

出　　处：《中国综合临床》2014年第9期925-928,共4页Clinical Medicine of China

摘　　要：目的 应用磁共振弥散张量纤维束成像（DTT）探讨不同时期脑梗死患者运动功能障碍的程度,观察梗死灶与皮质脊髓束（CST）的位置关系,从而早期判断患者预后.方法 将40例由于皮质脊髓束受损所致运动功能障碍的不同时期脑梗死患者（研究组）及30名健康对照组行DTT检查,进行CST三维重建,了解CST受损情况,同时应用日常生活活动能力（ADL）量表对患者入院时及治疗后2个月的ADL进行相关评分,从而了解患者预后情况.结果 研究组与对照组均作DTT成像,健康对照组双侧皮质脊髓束重建,解剖形态与正常人大致相吻合,自中央前回下行至内囊并延续至脑桥和延髓,每条连续形态一致性良好.研究组患者健侧皮质脊髓束形态与对照组一致,连续性好;患侧皮质脊髓束因受梗死区不同程度的影响,表现为连续性中断及解剖结构形态一致性的丧失.根据CST受累程度,1级9例、2级20例、3级11例.DTT所示CST的损伤程度与治疗后2个月ADL评分呈负相关（r=-0.914,P＜0.05）.结论 DTT图像可无创性的显示梗死灶与皮质脊髓束的空间位置关系,分析病灶对皮质脊髓束的影响,作为早期判断运动功能受损和评估预后的客观依据.Objective To investigate application of diffusion tensor tractography （DTT） on evaluating motor dysfunction degree of patients with cerebral infarction and explore the relationship between infracted focus and cortical spinal tract（CST）.Methods Forty patients with cerebral infarctions in the different periods and 30 healthy volunteers were enrolled our study.They all underwent DTT check and then established CST.Meantime,all the patients were measured ADL score according to activities of daily living （ADL） on admission and two months after the onset.Results DTT image was made for both in patients and health control people.The CST was built in people in control group and its shape was like the adults＇.Its shape was from the precentral gyrus down to internal capsule and continued to pontine and medulla oblongata.Each successive was form good consistency.The DTT image of patients＇ health side was like normal and injury corticospinal tract was affected by influence of infarction area at different level,manifested as loss of discontinuity and anatomical configuration consistency.Based on the degree of CST,there were 9 cases in grade Ⅰ,20 cases in grade Ⅱ and 11 cases at grade Ⅲ.DTT image showed that the damage level of CST had an negative relation with ADL score at 2 month after therapy （r =-0.914,P 〈 0.05）.Conclusion DTT can show the spatial positions of infarctions and CST at non-invasive lesion and analyze the influence of infarctions and corticospinal tract.Therefore,it can serve as the objective proof for judging the injury of the motor function and evaluating prognosis.

关 键 词：磁共振弥散张量纤维束成像 皮质脊髓束 日常生活活动能力量表 临床预后 

分 类 号：R445.2[医药卫生—影像医学与核医学]