弥散张量成像技术在急性脑梗死患者肢体功能恢复预测中的应用  

Application of diffusion tensor imaging in prediction of recovery of limb motor function of patients with acute cerebral infarction

作　　者：李鹏翔[1] 苏庆杰[1] 李传资 王柏平 曾超胜[1] 龙发青[1] 陈聪[1] 张余辉[1] 

机构地区：[1]海南省农垦总医院神经内科,海南省海口市570311 [2]海南省农垦总医院影像科,海南省海口市570311

出　　处：《中华全科医学》2015年第10期1597-1599,共3页Chinese Journal of General Practice

摘　　要：目的 应用弥散张量成像技术（DTI）对急性脑梗死患者的皮质脊髓束（CST）进行三维重建,评估CST的形态改变,同时结合日常生活活动能力评定量表（ADL）判断患者肢体功能及评估预后.方法 收集2012年6月-2013年6月在神经内科住院的39例急性脑梗死患者,初次发病,病程在3d内,均为颈内动脉系统梗死患者,有不同程度的一侧肢体瘫痪,梗死灶仅累及白质而无皮质灰质受侵,符合中国缺血性卒中诊治指南诊断标准.其中男性患者27例,女性患者12例,年龄49～75岁,平均年龄（62.03 ＆#177;5.57）岁,所有病例均行MRI、DWI及DTI检查,39例患者通过DTI检查后按锥体束受累情况不同分为3组.各组按神经内科常规治疗,并在治疗2周和治疗4周后分别进行ADL评定,依据ADL分值判定患者肢体功能损伤程度.所得数据运用SPSS 13.0进行统计分析.结果 CST受累程度低的患者经过治疗后其肢体功能恢复比CST受累程度高的患者好（F=26.76,F=30.22,P＜0.05）.并且CST受累程度较轻（CST受累为1级和2级）的患者随着治疗时间的推移,其肢体功能在逐渐恢复（t=5.38和t=3.21,P＜0.05）;CST受累较重（CST受累为3级）的患者虽然经较长时间的积极治疗,但其肢体功能恢复不明显（t =0.62,P＞0.05）.结论 弥散张量成像技术可以无创、直观显现梗死病灶对皮质脊髓束的损害,可对神经纤维损伤情况进行判定,对预测急性脑梗死患者肢体功能的恢复有一定价值.Objective To evaluatethemorphological changes by three-dimensional reconstruction of the corticospinal tract （CST）with diffusion tensor imaging （DTI）in patients with acute cerebral infarction （ACI）, and assess thelimb functionandprognosis of patients on the basis of scaling ADLs. Methods From June 2012 to June 2013,39 patients（ male 27 ,female 12, mean age （62.03 ± 5.57 ）years old ,range 49 to 75 years old） with ACI（ all were internal carotid artery infarc- tion） presenting within 3days of the onset were studied. All patients suffered varying degrees of unilateral limb movement dysfunction;the infarctinvolvedonlythewhite matter, which met theguidelines of ischemic stroke diagnosis and treatment. All patients underwent MRI, DWI and DTI examination ,39 patients were divided into 3 groups according to the different of pyramidal tract involvement. The patients in each group received the internal medicine routine treatment in neurological department, and ADL was measured in 2 and 4 weeks after the treatment to evaluate the damage degree of limb function. The data were analyzed by using SPSS 13. 0. Results Thelimb function of patient whoseeorticospinal tract was involved at low degree recovered better than others whose corticospinal tract was involved at high degree （ P 〈 0. 05 ）. And the limb function of patient whose eortieospinal tract was involved at mild degree（ the first and second grade） gradually recovered with treatment（ P 〈0.05 ） ;After a long time of active treatment,the limb function of patient whose corticospinal tract was involved severe（ the third grade） did notrecovered obviously（ P 〉 0.05 ）. Conclusion Diffusion tensor imaging can non- invasively and intuitively show theinfaretion lesions of the cortieospinal tract, have certain value to the predietion of the limb function recovery in patients with acute eerebral infarction.

关 键 词：弥散张量成像 脑梗死 肢体功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]