亚急性期脑卒中患者弥散张量成像与长期预后的关系

Long-term Functional Outcome Correlating with Diffusion Tensor Imaging of Subacute Stroke Patients

目的脑卒中后锥体束的继发性变性与卒中预后有关,其中卒中后1个月时的继发性变性与脑卒中长期预后的关系研究较少,本研究旨在探讨利用弥散张量成像技术评估发病后1个月时亚急性期脑卒中患者的锥体束继发性损害程度,分析其与长期预后的关系。方法收集30例有偏瘫体征的首次发病亚急性期卒中病例,在其距发病1个月时,基于感兴趣区方法在大脑脚锥体束解剖学区域测定两侧各项异性值(fractional anisotropy,FA),于发病后6个月时随访评定预后。其中,运动障碍程度采用美国国立卫生研究院卒中量表中的肢体运动功能条目(motor subindex of NIHSS,m-NIHSS)评定,日常生活自理能力采用功能独立量表(functional independence measures,FIM)评定,功能预后用改良Ranking量表(modified ranking scale,mRS)评定。结果病灶侧FA值显著低于非病灶侧FA值(P<0.001),病灶侧与非病灶侧的FA比值(ratio of fractional anisotropy,rFA)与6个月时的m-NIHSS、FIM、mRS具有显著的相关性(P<0.001,r=-0.741;P<0.001,r=0.670;P<0.001,r=-0.648)。结论发病1个月时的弥散张量成像检查在预测脑卒中患者的长期预后,特别是运动功能的恢复程度方面可能具有潜在的价值。

Objective It is unclear how wallerian degeneration （WD） of pyramidal tract（PT） in the subacute phase of stroke corre- lates with the long - term functional outcome. The aim of this study was to quantify and predict the long - term neuromotor outcome of pa- tients with stroke by diffusion imaging（DTI） in the subaeute phase. Methods Thirty patients with stroke were scanned with 1.5T super- conducting magnet with DTI about 1 month after onset prospectively. A region - of- interest based analysis was performed for the fractional anisotropy（FA） of the CST in the cerebral peduncles. The degree of paresis was assessed at 6 months in following by motor subindex of NIHSS （ m - NIHSS）. The ability of daily life was estimated by Functional Independent Measures（ FIM）. The functional outcome was eval- uated by the modified Ranking Scale（mRS）. Results The FA in the affected side at 1 month was significantly lower compared with that of the unaffected side（P 〈 0. 001 ）. The ratio of the FA （rFA） in the affected side to the unaffected at 1 month was significantly with m - N IHSS and FIM and the mRS score at the end of following（6 months）（P〈0.001,r= -0.741;P〈0.001,r =0.670;P〈0.001,r = -0. 648）. Conclusion DTI may be a promising technique in the role to forecast the motor deficit and may predict the functional out- come in patients with stoke who were in subacute phase after the stoke onset.