脊髓损伤截瘫患者序列对指运动fMRI研究  

Brain activation pattern during sequential finger-to-thumb opposition movement in paraplegic patients with spinal cord injury:a functional MRI study

作　　者：朱凌[1] 吴光耀[1] 文之[1] 李洁兰[1] 

机构地区：[1]武汉大学中南医院MRI室,武汉430071

出　　处：《放射学实践》2015年第12期1203-1207,共5页Radiologic Practice

基　　金：国家自然科学基金资助项目(81171315;81227902)

摘　　要：目的:采用血氧水平依赖功能磁共振成像(BOLD-fMRI)观察脊髓损伤(SCI)截瘫患者序列对指运动时的脑激活模式,探讨SCI后脑运动功能代偿重组机制。方法:12例手部感觉运动功能正常的SCI截瘫患者(SCI组)和12例健康志愿者(对照组)行序列对指运动fMRI扫描,采用组块设计,30s静息和30s右手序列对指运动交替进行,重复4次,总扫描时间240s。使用SPM8软件分析右手序列对指运动时个体水平、组内及组间水平的脑激活模式,分析SCI组对侧大脑激活最强点T值、对侧初级运动皮质(M1)激活体积与损伤平面、损伤后时间及运动评分之间的相关性。结果:两组中对侧激活最强点T值及M1激活体积的差异无统计学意义(P>0.05),SCI组对侧M1激活体积与损伤平面呈负相关(r=-0.807,P=0.009)。与对照组比较,SCI组对侧激活最强点向后移位,双侧M1、辅助运动区(SMA)、岛叶及顶下小叶激活增强。结论:脊髓损伤截瘫患者远隔部位运动相关脑区发生代偿重组,且与脊髓损伤平面相关。Objective：To investigate the activation pattern of motor associated brain area and to explore the mecha- nism of brain compensation and reorganization during sequential finger-to-thumb opposition movement in paraplegic patients with spinal cord injury （SCI） using blood oxygen level dependent （BOI.D） fMRI. Methods： A total of 12 paraplegic patients with SCI and 12 healthy controls underwent BOLD-fMRI during sequential finger to thumb opposition movement. The acti- vation experiment consisted of 30s periods of rest alternating with 30s periods of movement. The total acquisition time was 240s. The data were analyzed using Statistical Parametric Mapping （SPM） 8 software to show the activation of brain within groups and between groups. The contralateral maximum T value and the volumes of activation in the contralateral primary motor cortex （M1） were determined for each subject. Correlation analysis was carried out in SC1 group to explore relation- ships between the contralateral maximum T value, the volumes of activation in the contralateral M1 and the spinal cord level of injury, the time since SCI, the international standards for the neurological classification of spinal cord injury motor scores. Results：Statistical comparisons of the volumes of activation in M1 and the maximum T value did not reveal any significant differences between the SCI patients and the controls. The activation volumes of contralateral M1 were negatively correlated with the level of the spinal cord injury （r --0. 807,P 0. 009）. Compared with the controls,the position of maximum acti vation region showed a posterior displacement,and increased activation was found in bilateral primary motor cortex, supple mentary motor area,inferior parietal lobe and insula in patients with SCI. Conclusion：In paraplegic patients with spinal cord injury, compensation and reorganization in motor associated brain areas may exist and correlate with the level of injured spi nal cord.

关 键 词：脊髓损伤 功能磁共振成像 运动皮质 对指运动 重组 

分 类 号：R445.2[医药卫生—影像医学与核医学] R651.2[医药卫生—诊断学]