基于DTI技术的急性中风患者缺血脑白质纤维束的扩散性与神经功能恢复的相关性研究  

A correlation study between diffusivity of ischemic white matter fiber tract and neuro-functional recovery in patients with acute stroke by using DTI technique

作　　者：杨烁慧[1,2] 詹松华[1] 陆方[1] 李晨[1] 林江[2] 

机构地区：[1]上海中医药大学附属曙光医院放射科,上海200021 [2]复旦大学附属中山医院放射诊断科,上海200032

出　　处：《磁共振成像》2015年第10期727-733,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(青年)项目(编号:81403204);上海市卫生局青年科研项目(编号:20114y177)~~

摘　　要：目的通过扩散张量成像(diffusion tensor imaging,DTI)评价急性缺血性中风患者脑白质纤维束的扩散性与神经功能恢复的相关性,预测患者运动功能的恢复情况。材料与方法 40例临床诊断并经磁共振扫描证实有单侧急性脑白质梗塞并有运动功能障碍患者行DTI检查后,于治疗后1个月、2个月及3个月末行常规MRI和DTI检查,获得部分各向异性指数(FA)和表观扩散系数(ADC)。分别于缺血白质区域和对侧同名纤维束镜像区域取感兴趣区,测量FA值、ADC值后计算比值(r FA和r ADC)以及梗塞体积,观察其与美国国立卫生研究院脑中风评分(NIHSS)的相关性。其中32名1年后随访到的患者,根据其运动力指数(MI),分成恢复良好组和恢复不良组,运用r FA和r ADC判断运动功能的恢复情况。结果r FA、r ADC和梗塞体积于首诊、治疗1个月末、2个月末和3个月末之间均存在统计学差异(F=13.84,P=0.00,F=64.57,P=0.00和F=37.41,P=0.00)。首诊和1个月末r FA与NIHSS评分显著负相关(r=-0.59,t=-4.59,P=0.00和r=-0.34,t=-2.27,P=0.02);首诊r ADC与NIHSS评分显著负相关(r=-0.44,t=-3.04,P=0.00),1个月末、2个月末、3个月末r ADC与NIHSS评分显著正相关(r=0.28,t=1.83,P=0.04;r=0.39,t=2.69,P=0.00;r=0.63,t=4.99,P=0.00)。1月个末、2个月末、3个月末梗塞体积与N I H S S评分显著正相关(r=0.4 0,t=2.73,P=0.01;r=0.44,t=3.05,P=0.00;r=0.32,t=2.13,P=0.04)。多元回归分析显示首诊r FA和3个月末r ADC与患者1年后的MI有显著相关性(t=2.95,P=0.00和t=2.75,P=0.01),3个月末r ADC的ROC曲线峰下面积为0.905。结论DTI技术能显示急性脑缺血患者脑白质纤维束损伤治疗后的演变,其测定参数与神经功能恢复有一定相关性,3个月末ADC值或可用于预测患者运动功能恢复情况。Objective： To evaluate the correlation between diffusivity of ischemic white matter fiber tract and neuro-functional recovery in acute stroke patients by using DTI, and try to predict the motor outcome of these patients. Materials and Methods： Forty unilateral cerebral ischemic patients with motor dysfunction underwent MRI and DTI study within three days after the onset of illness. MRI and DTI scans were done one, two and three month after treatment. Fractional anisotropy（FA） and apparent diffusion coefficient（ADC） maps were obtained. With the reference of DW images,regions of interest（ROIs） were selected on the ischemic white matter fiber tract, and the control ROIs were selected on the contralateral homonymic white matter fiber tract. The ratios of FA and ADC（rFA and rADC） within these ROIs and infarction volume were calculated. The relationship between DTI parameters with infarction volume and national institute of health stroke scale（NIHSS） scores were assessed. According to motricity index（MI）, a total of thirty-two stroke follow-up patients after one year treatment were divided into no motor deficit group and motor deficit group and DTI parameters were used to predict the motor outcome. Results： Significant differences were found regarding rFA, rADC and infarction volume of ischemic white matter fiber tract among the onset, one, two and three months of the stroke patients（F=13.84, P=0.00; F=64.57, P=0.00 and F=37.41, P=0.00）. There was significantly negative correlation between rFA and NIHSS scores at the onset and one month（r=-0.59, t=-4.59, P=0.00; r=-0.34, t=-2.27, P=0.02） and between rADC and NIHSS scores at the onset（r=-0.44, t=-3.04, P=0.00）. There was significantly positive correlation between rADC and NIHSS（r=0.28, t=1.83, P=0.04; r=0.39, t=2.69, P=0.00; r=0.63, t=4.99, P=0.00） and between the infarction volume and NIHSS scores（r=0.40, t=2.73, P=0.01; r=0.44, t=3.05, P=0.00; r= 0.32, t=2.13, P=0.04） at one, two and three months from the onset. There

关 键 词：弥散磁共振成像 中风 脑缺血 脑白质病 白质纤维束损伤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]