丘脑梗死患者灰质体积改变与运动功能相关性的随访研究  

The relationship between dynamic gray matter volume changes and motor recovery in patients after thalamus infarction

作　　者：王佩佩[1,2] 李琼阁 单艺 马青峰[3] 赵澄 张苗[1,2] 卢洁[1,4,2] WANG Peipei;LI Qiongge;SHAN Yi;MA Qingfeng;ZHAO Cheng;ZHANG Miao;LU Jie(Department of Radiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,P.R.China;Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,P.R.China;Department of Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,P.R.China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics,Beijing 100053,P.R.China)

机构地区：[1]首都医科大学宣武医院放射科,北京100053 [2]磁共振成像脑信息学北京市重点实验室,北京100053 [3]首都医科大学宣武医院神经内科,北京100053 [4]首都医科大学宣武医院核医学科,北京100053

出　　处：《医学影像学杂志》2019年第3期345-349,共5页Journal of Medical Imaging

基　　金：国家自然科学基金项目(编号:81522021;81671662);北京市医管局人才培养计划"登峰"项目(编号:DFL20180802)

摘　　要：目的采用基于体素形态学方法(voxel-based morphometry,VBM),研究单侧丘脑梗死患者脑灰质结构动态改变,探讨丘脑梗死患者运动功能恢复的脑结构重塑机制。方法选取13例单侧丘脑梗死患者分别于发病<7天,14天、30天、90天、180天进行MRI三维高分辨全脑容积扫描。同时对患者进行Fugl-Meyer(FM)运动量表评分。选择性别及年龄匹配的13例健康志愿者作为对照组。运用SPM12软件对所有受试者的全脑高分辨图像进行VBM分析,显示丘脑梗死组组内各时间点间存在灰质体积差异的脑区。从基于VBM分析结果中选取与运动相关的脑区—辅助运动区(supplementary motor area, SMA)作为感兴趣区(region of interest, ROI),提取丘脑梗死患者各时间点的SMA灰质体积及正常受试者SMA灰质体积,观察SMA脑区灰质体积动态变化,将其与临床FM评分变化进行相关性分析。结果丘脑梗死组组内各时间点VBM比较结果显示脑内既存在脑灰质体积减少脑区,也存在脑灰质体积增加脑区(P<0.00001,FDR校正)。其中与运动相关SMA脑区灰质体积变化趋势显示,发病后14天与发病后7天内SMA区灰质体积明显增加。随之,30天、90天及180天较14天SMA区灰质体积略有下降,且各时间点SMA区灰质体积均低于正常对照组。相关分析结果显示丘脑梗死组SMA脑区灰质体积变化绝对值与FM评分变化绝对值呈正相关(r30～7天=0.76,P<0.05;r90～7天=0.59,P<0.05)。结论单侧丘脑梗死患者SMA区脑结构重塑对患者运动功能恢复具有重要作用。Objective To explore the correlations between dynamic gray matter changes and clinical prognosis in patients with thalamus infarction by voxel-based morphometry(VBM). Methods Thirteen patients with infraction of unilateral thalamus were scanned and neurologically assessed 5 times after the stroke(within 7 days, 14 days, 30 days, 90 days, and 180 days after stroke onset) underwent 3 D high resolution whole brain volume MRI scans(3.0 T, Trio, Siemens). Thirteen age-sex matched healthy participants were also examined head MRI. The motor deficits of patients were evaluated with Fugl-Meyer(FM) motor scale at 5 times after thalamus infarction. The dynamic changes of gray matter volume(GMV) were assessed using VBM(SPM12, http://www.fil.ion.ucl.ac.uk). The differences of gray matter volume change in thalamus infarction patients between 7 days and 14 days, 30 days,90 days, and 180 days after stroke onset were compared respectively. The gray matter volumes of SMA at each time point of patients group and normal group were extracted. Furthermore, the correlation between GMV changes in region of SMA and FM scores was analyzed. Results Whole-brain VBM analysis revealed that the significantly both decreased and increased GMV in thalamus infarction group at different time point(P<0.00001, FDR corrected). The GMV in motor related region-SMA was increased compared 7 th day after stroke onset with 14 days after stroke onset. Then, SMA area gray matter volumes decreased slightly at 30 days, 90 days and 180 days related to 14 days after stroke onset. And GMVs of SMA in patients with thalamus infarction were less than those of normal control group at 6 months follow up time. Further correlation analysis showed that there was a positive correlation between the absolute value of SMA gray matter volume change and the absolute value of FM score change in the thalamus infarction group( r 30 ~ 7 days = 0. 76,P < 0. 05;r 90 ~ 7 days = 0. 59,P < 0. 05). Conclusion The structural remodeling of motor related region-SMA might contribute to motor

关 键 词：丘脑梗死 灰质体积 磁共振成像 

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]