磁共振DTI及DTT评估脑梗死皮质脊髓束损伤的临床应用研究  

Correlation study between prognosis and corticospinal tract injury of cerebralinfarction assessed by diffusion tensor imaging( DTI) and diffusion tensor teactography( DTT)

作　　者：阮锦荣 牛鹏 彭永军 孙莉 黄婷婷 黄干 黄海峰 陈婵清 

机构地区：[1]广东省阳江市中医医院影像科,529500 [2]广东省阳江市中医医院神经内科,529500

出　　处：《现代医用影像学》2017年第3期559-563,共5页Modern Medical Imageology

基　　金：广东省阳江市科技工业和信息化局科研项目(编号:卫2012-48)

摘　　要：目的:应用磁共振扩散张量成像(DTI)及扩散张量纤维束成像(DTT)评价脑梗死患者皮质脊髓束(CST)损伤程度及与运动功能预后的关系。方法:选择符合纳入标准的脑梗死患者100例进行常规头颅MRI扫描及全脑DTI数据采集,应用DTT技术进行双侧皮质脊髓束三维重建,判断CST受损程度及损伤评分。在发病7d内和3个月时测量脑梗死区及健侧相应区域白质各向异性分数(FA),采用Fugl-Meyer量表进行运动功能评分,将CST受累程度分为4级。采用方差分析、Pearson和Spearman相关分析,分析脑梗死区FA值及CST受累程度与运动功能恢复的关系。结果:发病7d内和3个月时3组FA的变化幅度(0.05±0.07、0.08±0.06、0.18±0.01)、(0.11±0.02、0.22±0.06、0.38±0.04),差异有统计学意义(7d内F=32.821,3个月时F=192.372,均P<0.05)。DTT显示CST病变侧表现为受压、变形、移位和中断。发病7d内CST级与患者肢体肌力呈负相关(r=-0.682,P<0.01),3个月复查CST等级与患者肢体肌力呈负相关(r=-0.728,P<0.01)。结论:脑梗死患者梗死区FA值降低及CST受累程度均与运动功能预后有关。磁共振DTT能直观显示CST受累程度,可以为早期判断脑梗死预后提供重要依据。Objective： To evaluate the relationship between the degree of corticospinal tract（ CST） injury and motor function prognosis in patients with cerebral infarction using magnetic resonance diffusiontensor imaging（ DTI） and diffusion tensor teactography（ DTT） imaging. Methods： 100 patients with cerebral infarction meeting the inclusion criteria were proceeded regular head MRI scan and whole brain DTI data acquisition,and the DTT technique was used to perform CST 3D reconstruction to evaluate CST injury. The white matter fractional anisotropy（ FA） of the infarct zones and contralateral corresponding regions was measured within 7 days and at 3 months after onset. The Fugl-Meyer scale was used to perform motor function defect score. The CST involvement degrees were divided into four grades. The analysis of variance,Pearson,and Spearman correlation analysis were used to analyze the relationship between FA values,CST involvement degrees and motor function recovery. Results： There were significant differences in the amplitude ofvariation of FA within 7 d（ 0. 05 ± 0. 07,0. 08 ± 0. 06,and 0. 18 ± 0. 01） and at 3 months after onset（ 0. 11 ± 0. 02,0. 22 ± 0. 06,and 0. 38 ± 0. 04）（ within 7 d F= 32. 821,at 3 months F = 192. 372,all P 〈 0. 05）. DTT showed that the lesion sides of CST were presented as compression,deformation,displacement,and interruption. The CST grades were negatively correlated with the neurological functional rehabilitation of the patients within 7 d after onset（ r =-0. 682,P 〈 0. 01）. The CST grades were negatively correlatedwith the neurological functional rehabilitation of the patients at 3 months（ r =-0. 728,P 〈 0. 01）. Conclusion： The decreased FA values in infarct areas and the degrees of CST involvement were associated with the motor function prognosis. MR DTT can directly display the degrees of CST involvement of cerebral infarction. It can provide an important basis for early identifying the prognosis of cerebral infarction.

关 键 词：脑梗死 磁共振扩散张量成像 扩散张量纤维束成像 皮质脊髓束 预后 

分 类 号：R445.2[医药卫生—影像医学与核医学]