扩散张量成像与急性脑干缺血性卒中患者运动功能预后的相关性

Diffusion Tensor Imaging in Predicting the Motor Function of Patients with Acute Ischaemic Stroke in the Brainstem

目的探讨磁共振扩散张量成像(DTI)诊断及预测急性脑干缺血性卒中患者运动功能的价值。资料与方法 20例急性脑干缺血性卒中患者及20例健康成人(对照组)进行DTI检查,测量梗死灶及对侧相应部位各向异性分数(FA),患侧及健侧大脑脚、内囊后肢FA值,皮质脊髓束的数量和长度;同时测量对照组左、右侧对应区域的指标。观察FA值、皮质脊髓束的数量和长度与缺血性脑卒中患者入院时、卒中后3个月及6个月美国国立卫生研究院卒中评分量表(NIHSS)评分的相关性。结果脑干缺血性卒中患者的梗死灶、梗死侧大脑脚、内囊后肢FA值及梗死侧皮质脊髓束的数量均显著低于健侧(P<0.05),卒中第1周梗死侧大脑脚相对FA(r FA)与卒中入院时、卒中3个月及6个月的NIHSS评分(r=-0.51、-0.56、-0.60,P<0.05)、上下肢肌力评分(r=-0.60、-0.51、-0.62,P<0.05)呈显著负相关,而梗死灶、患侧内囊后肢r FA及梗死侧/健侧纤维束数量、长度比值与NIHSS评分、肌力评分无明显相关性。结论大脑脚的r FA(<7 d)有助于临床早期评价及预测急性脑干梗死患者的运动功能恢复。

Purpose To explore the significance of MR diffusion tensor imaging （DTI） in diagnosing and predicting the motor function of patients with acute ischemic stroke in the brainstem. Materials and Methods Twenty patients with acute ischemic stroke in the brainstem and 20 normal controls were enrolled in the study. DTI was performed on all 40 subjects. Fractional anisotropy （FA） in specific regions were measured including infarction lesions, cerebral peduncle, the posterior limb of the internal capsule in the affected side and corresponding unaffected regions. The number and the length of the corticospinal tracts （CST） of both affected and unaffected sides were also measured. The correlation of FA, the number and the length of the CST, the NIH stroke scale （NIHSS） at the admission, 3 months and 6 months was analyzed. Results The FA values of infarction, cerebral peduncle, and the posterior limb of the internal capsule, and the number of CST in the affected side were significantly less than that of the corresponding unaffected regions （P＆lt;0.05）. The rFA （〈7 d） in the affected cerebral peduncle was negatively correlated with NIHSS and the score of the upper and lower extremity muscle strength at the admission, after 3 months and after 6 months （P〈0.05）. However, the rFA of the infarction and the posterior limb of the internal capsule, the ratio of the number and the length of CST of affected/unaffected sides had no correlation with NIHSS score and the score of the muscle strength. Conclusion The rFA in the cerebral peduncle is helpful for early evaluation and predicting recovery of the motor function in the patients with acute ischemic stroke in the brainstem.