采用纤维束成像研究皮质脊髓束损伤与脑梗死预后的关系

Correlation of Corticospinal Tract Injury and Prognosis of Cerebral Infarction:MR Fiber Tractography

目的:利用纤维束成像技术探讨皮质脊髓束(CST)损伤对脑梗死预后的预测价值。材料和方法:19例累及基底节、内囊或者放射冠区等白质区域而无皮质灰质受累的急性脑梗死患者在3.0T MR仪上进行了全脑弥散张量成像(DTI)检查。DTI数据在个人电脑上采用三个感兴趣区(ROI)并利用线性扩展法进行皮质脊髓束三维重建,通过比较梗死病灶和CST的空间关系,判断卒中后CST受损的类型及其损伤程度,对卒中后预后的评价采用改良的Rankin量表评分(mRS评分)。CST受损的程度和发病3个月的mRS评分进行比较,同时比较病灶大小和预后之间的相关性。结果:梗死灶和皮质脊髓束(CST)的关系有3种:CST完整、CST部分受侵和CST完全受侵。CST完整的患者恢复最好,CST完全受侵的患者预后较差,CST部分受侵的患者预后介于两者之间,三者的预后差异显著(F=15.14,P<0.001)。卒中后患者的预后与CST受侵犯的程度密切相关(r= 0.81,P<0.01),而和病灶的大小之间没有显著的相关性(r=0.383,P=0.105)。结论:利用纤维束成像能够显示脑梗死后皮质脊髓束损伤情况,皮质脊髓束的损伤与脑梗死预后不良密切相关。

Purpose： To explore the value of fiber tractography in revealing corticospinal tract（CST） injury after ischemic stroke in outcome prediction. Materials and Methods： Diffusion tensor imaging were performed in 19 acute ischemic stroke patients involved basal ganglia, internal capsule or corona radiate. All raw DICOM data were transformed to personal computer to rebuild the white matter tract using volume - one 1.64 and diffusion TENSOR visualizer （dTV. Ⅱ . R1） . Three seeds were used to reconstruct the corticospinal tract. The spatial relationship between the lesion and CST was analyzed. Modified rankin scale （mRS） was used to evaluate the clinical outcome. The degree of CST injury and the lesion volume were compared with the 3 - month mRS scores. Results： Three patterns of CST involvement were identified： intact, partially involved and completely involved. Different pattern had totally different clinical outcome（F = 15.14, P 〈 0.001）, CST intact had a fully recovery, patients with CST completely involved had a lowest mRS scores. 3- month mRS scores were directly related to the degree of CST involvement（ r = 0.81, P 〈 0.01）, and not related to stroke volume（ r = 0.383, P = 0. 105）. Conclusion： Fiber tractography can show CST injury in patients with stroke, and CST injury is closely correlated with the prognosis of such patients.