卒中后失语症患者弓状纤维弥散张量成像研究

Study on the arcuate fasciculus of post-stroke aphasia with diffusion tensor imaging

目的:运用弥散张量成像技术(DTI)对卒中后失语症患者大脑双侧弓状纤维束形态结构在语言康复治疗前后改变情况进行观察和分析,以期探讨大脑白质纤维结构在卒中后失语症恢复机制中的作用.方法:对1例卒中后失语症患者进行5个月的语言康复治疗,在治疗前后分别进行汉语失语成套测验(ABC)评估和DTI扫描,观察各语言功能亚项和大脑双侧弓状纤维束形态结构的改变,并分析各语言功能亚项改变与双侧弓状纤维束形态结构变化之间的关系.结果:经过5个月的语言康复治疗,患者ABC各语言分项治疗前后得分百分比为:听理解(治疗前66.38%,治疗后69.40%);命名(治疗前84.76%,治疗后84.76%);复述(治疗前64.00%,治疗后72.00%);口语表达(治疗前69.81%,治疗后81.13%),其中听理解和命名功能未见明显改善,而复述和口语表达改善较明显.在口语表达分项的各亚项中,信息量(治疗前66.67%,治疗后83.33%)和流利性(治疗前48.15%,治疗后66.67%)得分明显提高.复述分项中则以句复述亚项得分百分比提高为主,从治疗前的52.63%提高到63.16%.DTI纤维追踪结果显示患者双侧弓状纤维束的纤维数量和致密性增加并出现损伤部位的结构重建.结论:卒中后失语症患者经过语言康复治疗后大脑双侧弓状纤维束可发生完整性增加及结构重建等改变,这种改变可能参与语言功能的恢复.

Aim： To explore the role of the white matter fiber in the recovery mechanisms of post-stroke aphasia by observing the shape and structure of the bilateral arcuate fasciculus（AF） using diffusion tensor imaging. Methods： One post-stroke aphasia patient received five-month language therapy,Both Aphasia Battery of Chinese（ABC） and diffusion tensor imaging（DTI） were performed before and after therapy to observe and analyze the changes of language function and bilateral AF. Results： After five-month language therapy,the ABC score percentage of audio comprehension,nomination,oral expression and repetition were changed from 66. 38% to 69. 40%,84. 76% to 84. 76%,69. 81% to 81. 13% and64. 00% to 72. 00% respectively. Among these items,audio comprehension and nomination were onlyimproved less,while oral expression and repetition were improved a lot. In oral expression,the ABC score percentage of information content and fluency were improved significantly from 66. 67% to 83. 33%and 48. 15% to 66. 67% respectively. In the subitems of repetition only the sentence repetition score percentage was increased evidently from 52. 63% to 63. 16%. DTI showed that the quantity and the compactness of bilateral AF were increased and the reorganization in the damaged area was also observed.Conclusion： After language therapy,the increased integrity and reorganization can take place in bilateral AF,and all these changes may take a role in the recovery of the language function of post-stroke aphasia.