缺血性脑卒中肢体运动功能及皮质脊髓束受损的DTI评价

Evaluation of the Relationship between Extremity Motor Function Impairment and Cortical Spinal Tract Involvement in Cerebral Ischemic Stroke with Diffusion Tensor Imaging (DTI)

目的:探讨脑缺血性卒中急性期患者肢体运动功能与皮质脊髓束受损的关系。方法:采用GE1.5T磁共振成像系统,对9例脑缺血性卒中急性期患者和9例志愿者进行磁共振扩散张量成像(DTI)检查,采用dTV.Ⅱ软件进行处理,显示FA图及彩色FA方向图,并重建患者的双侧皮质脊髓束3D纤维图。Brunnstorm标准判断脑卒中患者患手肌力。结果:卒中患者梗死白质区FA值显著低于健侧,两侧相比差异有显著性意义(t=4.570,P<0.001),病变侧皮质脊髓束受压、变形、移位、部分断裂,皮质脊髓束受累情况与肌力有相关性(rs=0.888,P<0.05)。结论:脑卒中患者患手皮质脊髓束损伤程度与肌力相关,提示可用于判断康复治疗的预后。3D纤维图可以更立体直观的显示锥体束状况。

Objective：To evaluate the relationship between the impairment severity of cortical spinal tract （CST） and muscle strength in acute ischemic stroke patients. Methods, DTI was respectively performed in 9 patients with acute cerebral ischemic stroke and a control group of 9 volunteers using a GE Signa Excite MR scanner, dTV.Ⅱ software was used for fiber tracking. Fractional anisotropy （FA） maps and 3D tractography of bilateral CST of all patients and volunteers were created. Brunstorm criteria were used to evaluate the hand motor function. Results：The FA values of the white matter in infarction area were significant lower than those of their counterparts in the normal hemisphere （paired test, t = 4. 570, P〈0. 001）. Correlation between the changes of FA values in the infarction area and the impairment of relative muscle strength of the hand （spearmen correlation, r= 0. 888, P〈0.05） was noted, and DTI showed that the corresponding CST was compressed,shifted and partly torn. Conelution： In acute cerebral ischemic stroke, the impairment severity of CST of the hand was corre-latively related to its changes in muscle strength,therefore,DTI was indicated to serve as a predictive means for the effect of rehabilitation treatment and disease prognosis. Moreover,3D fiber tractographic maps displayed ＂real＂ and more stereo images of the pyramidal tracts.