磁共振弥散张量成像在脑梗死亚急性期评估患者康复水平的应用

The Application of Magnetic Resonance Diffusion Tensor Imaging in the Evaluation of Cerebral Infarction Patients Recovery Level in the Subacute Stage

目的分析脑梗死患者急性期、亚急性期和慢性期应用磁共振弥散张量成像技术(DTI)检测各测量参数和患者预后的相关性。方法 153例符合筛选条件的新患脑梗死患者,分别在急性期、亚急性期和慢性期应用DTI跟踪监测损伤侧病灶区和对称相同脑区的各参数值,包括平均扩散系数(DCavg)、容积比各向异性(VRA)、部分各向异性(FA)和衰减指数(Exat);最后根据MBI评分结果将患者分成康复组和未康复组。结果在急性期两组病灶区VRA值较其对侧均明显下降(P<0.05);亚急性期康复组病灶ROI的VRA值较急性期未见改变,未康复组病灶ROI的VRA值继续降低,与康复组病灶ROI比较有统计学差异(P<0.05);在慢性期康复组病灶ROI的VRA值与急性期及亚急性期仍无统计学差异,未康复组病灶ROI的VRA值继续减少,且与康复组病灶ROI之间统计学差异呈扩大趋势(P<0.01)。在急性期两组的Exat值和其对侧ROI相比明显升高(P<0.05);在亚急性期康复组的Exat值明显下降,与其对侧ROI无统计学差异,而未康复组的Exat值下降缓慢,与其对侧ROI和康复组病灶ROI相比仍具有统计学差异;到慢性期康复组的Exat值恢复到正常水平,而未康复组病灶ROI的Exat值下降不多,和其对侧ROI以及康复组的病灶ROI相比仍有差异(P<0.05)。结论应用磁共振扩散张量成像技术(DTI)检测的以上个参数值可以综合分析患者的预后是否良好,可以指导脑梗死临床康复治疗进行个性化方案的制定。

Objective We analyze the correlationship of the prognosis of patients and parameters value using magnetic resonance diffusion tensor imaging technology(DTI)on patients with cerebral infarction in acute,subacute and chronic phases.Methods A total of eligible153 cases of new cerebral infarction patients was detected by using DTI in focal zone of damage side and the contralateral brain region in different phases respectively,including the Average Diffusion Coefficient(DCavg),Volume Ratio Anisotropy(VRA),Fractional Anisotropy(FA)and the Exponential attenuation(Exat).Finally according to the results of MBI score the patients were divided into rehabilitation group and the group that was not rehabilitated(no rehabilitation group).Results In acute phase the VRA value from the focal zone of the two groups were significantly decreased than the contralateral area(P<0.05).In subacute phase the VRA value of ROI of rehabilitation group had no change compared with acute phase,the VRA value of ROI in no rehabilitation group continued to reduce,and is statistically significant with rehabilitation group(P<0.05).In the chronic phase the VRA value in the lesion areas of rehabilitation group is still no statistical difference with the acute phase and subacute phase,while the VRA value in lesion areas of no rehabilitation group continued to reduce,and showed the more statistical difference with rehabilitation group(P<0.01).In the chronic phase the DCavg values in no rehabilitation group continued to rise,while the rehabilitation group increased slowly,the no rehabilitation group was increased more obviously compared with the other group(P<0.01).In the subacute stage the Exat value of rehabilitation group was decreased,no statistical difference compared with the contralateral ROI,but the Exat value was dropped slowly in the no rehabilitation group,still statistically difference compared with the contralateral ROI and the rehabilitation group;In chronic phase the Exat value in the rehabilitation group returned to normal level,but the Exat value of ROI in the no rehabilitation group dropped not much,and still had differences with contralateral ROI and the rehabilitation group(P<0.05).Conclusion By application of magnetic resonance diffusion tensor imaging(DTI)to obtain these parameter values,we can comprehensively analyze the prognosis of patients with cerebral infarction,and formulate personalized scheme for clinical rehabilitation therapy for cerebral infarction patients.