脑卒中患者康复治疗前后皮质脊髓束的磁共振弥散张量成像研究

Corticospinal Tract Repairment Associated with Rehabilitation in Stroke Patients: A Diffusion Tensor Imaging Study

目的：探讨脑卒中患者康复治疗前后皮质脊髓束修复与运动功能改变的相关性。方法选择病程4~8周、病变部位为内囊基底节区，且皮质脊髓束受累的脑卒中偏瘫患者15例，分别于康复前和康复3个月后行磁共振弥散张量成像（DTI）检查，从大脑脚、内囊后肢、放射冠区3个层面，测量病变同侧皮质脊髓束和病变对侧相应脑组织的部分各向异性值（FA），计算FA比值（rFA）及FA不对称性（FAasy）。同时对偏瘫肢体进行简化Fugl-Meyer运动功能评定（FMA）。治疗前后FA、rFA、FAasy差值与FMA差值进行相关性分析。结果治疗后，患者FMA评分较治疗前明显提高（〈0.01）。治疗前后病灶侧FA值均较对侧相应脑组织降低。放射冠层面病灶侧FA、rFA、FAasy治疗前后有显著性差异（〈0.05）；大脑脚和内囊层面各参数治疗前后无显著性差异。治疗前后放射冠层面DTI各参数差值与FMA差值间无明显相关性。结论 DTI可用于评估脑卒中后皮质脊髓束损伤及修复，以放射冠层面皮质脊髓束的DTI参数最有意义。

Objective To explore the relationship between corticospinal tract （CST） repairment and motor function recovery after reha-bilitation in stroke patients by diffusion tensor imaging （DTI）. Methods 15 stroke patients with internal capsule lesions and injured CST, 4-8 weeks after onset were included. They were scanned with DTI and assessed with the simple Fugl-Meyer Assessment （FMA） before and after 3-month rehabilitation. The fractional anisotropy （FA）, FA ratio （rFA） and FA asymmetry （FAasy） in cerebral peduncle, posterior limb of in-ternal capsule （PLIC） and corona radiate were obtained. The correlation of differences of FA, rFA and FAasy of CST with FMA was ana-lyzed. Results The scores of FMA increased after treatment （〈0.01）. The FA of the ipsilesional CST were significantly less than that of con-tralesional ones before and after rehabilitation. There was statistical differences in FA, rFA and FAasy in the corona radiate section of CST after treatment （〈0.05）, but was not in the cerebral peduncle and PLIC section. However, there was no significant correlation of FA, rFA and FAasy of corona radiate section to scores of FMA. Conclusion DTI can respond to the repairment of corticospinal tract after stroke, es-pecially in the corona radiate section.