慢性缺血性脑卒中患者下行运动纤维束的扩散张量成像的诊断价值

Investigating the descending motor tracts in patients with chronic ischemic stroke with diffusion tensor imaging

目的 采用扩散张量成像技术（DTI）探讨慢性缺血性脑卒中患者,下行运动纤维束的完整性与运动预后的关系.方法 收集2012年4月至2013年12月东南大学附属中大医院慢性缺血性脑卒中患者47例（卒中组）;匹配健康志愿者20名（健康对照组）.采集DTI数据,重建双侧下行运动纤维束,包括皮质脊髓束（CST）及辅助运动纤维束（aMF）,并评估卒中组患侧与健侧CST及全部下行运动纤维束（CST＋ aMF）数量,观察该值及其偏侧性指数（LI）与Fugl-Meyer上肢运动量表（FMA）的相关性.并根据下行纤维束损伤形态将卒中组分为CST＋ aMF（组1）,无CST及aMF（组2）,CST（组3）和aMF（组4）四个亚组,观察各组FMA变化.结果 卒中组患侧CST及（CST＋ aMF）的数量均明显低于健康对照组（均P＜0.01,CST：26±30,CST＋ aMF：37±37）.组1、2、3间FMA比较差异有统计学意义（55±12、16±10、34±15,F=24.2,P＜0.01）.CSTLI、（CST＋ aMF）LI与FMA呈显著线性负相关（均P＜0.01,r=-0.653;r=-0.692）,（CST＋ aMF）LI与FMA相关性较CSTLI更显著.结论 相较于CST,CST＋ aMF能更好地评估卒中患者运动预后情况.在卒中患者运动功能康复过程中,要重视aMF的补偿作用,从而指导临床进行个性化的康复治疗.

Objective To evaluate the relationship between structural integrity of descending motor tracts and motor status in patients with chronic ischemic stroke using diffusion tensor imaging （DTI）.Methods From April 2012 to December 2013,47 patients with chronic ischemic strok were recruited along with 20 matched normal controls.The DTI data was acquired and preprocessed.Bilateral descending motor tracts includingcorticospinal tract （CST） and alternate motor fibers （aMF） were constructed.The descending motor tracts numberswere acquired and the relationships between laterality indices （LI） of descending motor tracts numbers and FMA were assessed.The patients were grouped into （CST ＋ aMF） group （group1）,no （CST ＋ aMF） group （group2）,CST group （group3） and aMF group （group4） according to the damage morphology of descending motor tracts.Observing the changes of each group.Results Ipsilesional CST and theentiredescending motor tracts numbers （aMF ＋ CST） were lower in the patient group as compared to the control group（P 〈 0.01,CST：26 ± 30,CST ＋ aMF：37 ± 37）.The FMA were statistically different between group1,2,3（55 ± 12,16 ± 10,34 ± 15,F =24.2,P 〈0.01）.The LI of CST and （CST ＋ aMF） significantly diagnosed motor impairment （P 〈 0.01,r =-0.653;r =-0.692）.Meanwhile,it is a stronger parameter when entire descending motor tracts were combined comparing to using the CST only.Conclusions The integrity of entire descending motor tracts,not merely the CST,appears to account for stroke recovery.Our results highlight the role of aMFin compensatory function,which may be used as a target in future rehabilitative treatmentsto promoting motor function recovery at the most extent.