脑卒中后吞咽障碍患者下丘脑功能连接和全脑各向异性的磁共振成像研究

Functional Connectivity from Hypothalamus and Whole Brain Anisotropy in Patients with Dysphagia after Stroke:A Study with Magnetic Resonance Imaging

目的观察脑卒中后吞咽障碍患者下丘脑功能连接和脑白质结构的影像学改变。方法2018年12月至2019年12月,选择卒中后吞咽障碍患者14例(患者组)和年龄、性别、优势半球相匹配的健康志愿者15例(对照组),以下丘脑为种子点,静息态功能磁共振成像观察与全脑功能连接变化,提取组间存在显著性差异脑区与进食评估工具(EAT-10)评分进行相关性分析;弥散张量成像观察两组各向异性分数(FA)有差异的脑区。结果与对照组相比,患者组左侧下丘脑与左侧中央前回、左侧中央后回、左侧边缘叶、左侧顶叶、左侧枕叶功能连接减弱,与左侧丘脑、左侧中脑、右侧枕叶功能连接增加;右侧下丘脑与右侧中央前回、双侧边缘叶、双侧颞上回、右侧顶叶功能连接减少,与双侧顶叶、双侧枕叶功能连接增加。EAT-10评分与左侧下丘脑和左侧中央前回(r=-0.595,P=0.025)、左侧中央后回连接呈负相关性(r=-0.934,P<0.001),与左侧下丘脑和左侧顶叶(r=0.583,P=0.028)、右侧下丘脑和左侧枕叶连接呈正相关(r=0.630,P=0.016)。与对照组相比,患者组FA降低的脑区为双侧中央前回、双侧中央后回、双侧顶叶、双侧枕叶、双侧额叶、双侧尾状核、双侧丘脑、右侧颞上回、右侧延髓、右侧桥脑和左侧小脑后叶,FA升高的脑区为双侧小脑前叶和右侧扣带回。结论运动、感觉皮质对吞咽活动十分重要;脑卒中后吞咽障碍患者可能需要更多的注意、视觉代偿;脑卒中后吞咽障碍患者在吞咽皮质、皮质下结构和脑干吞咽中枢存在广泛的白质完整性受损。

Objective To investigate the changes of the functional connectivity of hypothalamus and the whole brain anisotropy in patients with dysphagia after stroke using magnetic resonance imaging.Methods From December,2018 to December,2019,14 patients with dysphagia after stroke and 15 healthy controls matched in age,sex and dominant hemisphere were selected.The functional connections from bilateral hypothalamus were researched with resting-state functional nuclear magnetic resonance,and the correlation between functional connection and scores of Eating Assessment Tool-10(EAT-10)was analyzed.Meanwhile,the whole brain white matter integrity was observed with diffusion tensor imaging,and the fraction anisotropy(FA)was compared.Results Compared with the controls,the functional connections from left hypothalamus to left precentral gyrus,left postcentral gyrus,left marginal lobe,left parietal lobe and left occipital lobe decreased in the patients;while the functional connections to left thalamus,left midbrain and right occipital lobe increased;the functional connections from right hypothalamus to right precentral gyrus,bilateral marginal lobe,bilateral superior temporal gyrus and right parietal lobe decreased;the functional connection to bilateral parietal lobe and bilateral occipital lobe increased.There was negative correlation of EAT-10 scores to functional connection from left hypothalamus to left precentral gyrus(r=-0.595,P=0.025)and left postcentral gyrus(r=-0.934,P<0.001),and positive correlation to functional connections from left hypothalamus to left parietal lobe(r=0.583,P=0.028)and from right hypothalamus to left occipital lobe(r=0.630,P=0.016).Compared with the controls,FA decreased in bilateral precentral gyrus,bilateral postcentral gyrus,bilateral frontal lobe,bilateral parietal lobe,bilateral occipital lobe,bilateral caudate nucleus,bilateral thalamus,right medulla,right superior temporal gyrus,right pontine and left posterior cerebellar lobe in the patients;while FA increased in bilateral anterior lobe of cerebellum and right cingulate gyrus.Conclusion The motor and sensory cortices are important for swallowing.Patients with dysphagia after stroke may spend more attention and visual compensation.Impairment of white matter is found in swallowing cortex,subcortical structure and brainstem swallowing center in patients with dysphagia after stroke.