脑梗死患者磁共振扩散张量纤维束成像的随访研究

目的应用磁共振扩散张量纤维束成像(DTT)研究梗死灶与皮质脊髓束的空间关系,并随访观察受损纤维束的功能重组与代偿情况,探讨DTT技术对预测患者运动功能转归的价值。方法选择左侧内囊周围区脑梗死患者19例,分别于发病7、30、90天进行磁共振扩散张量成像(DTI)检查,应用DTT技术进行皮质脊髓束三维重建,采用FuglMeyer量表评价患者的运动功能,分析脑梗死灶及皮质脊髓束受累程度与患者运动功能恢复的关系。结果 DTT显示19例左侧内囊周围区梗死患者,根据患侧皮质脊髓束受累情况分为3型,I型5例,皮质脊髓束位于梗死灶外,FM评分96.46±7.68;II型6例,皮质脊髓束部分位于梗死灶内,但受侵范围1/3;或受压、迂曲、推移改变,FM评分94.20±6.84;III型8例,皮质脊髓束1/3位于梗死灶内,FM评分82.37±22.14。19例患者发病7天,皮质脊髓束损伤分型与FM评分呈显著负相关(r=-0.490,P=0.033)。DTT对患者皮质脊髓束的动态观察显示,8例III型患者中4例90天皮质脊髓束显示良好,患者运动功能完全恢复;2例患者皮质脊髓束自身发生再生修复,90天后仅遗留部分运动功能障碍;2例未发现纤维再生修复,90天仍遗留严重运动功能障碍。结论 DTT能够直观显示脑梗死患者的皮质脊髓束受累程度及其动态变化,对评价其运动功能恢复提供重要的客观影像学依据。

The predictive value of diffusion tensor tractography in the evaluation of motor function recovery in patients with cerebral in-farction

Objective To explore the evolution of diffusion tensor characteristics in different stages of cerebral infarction and their relationships with motor function recovery .Methods 19 patients with pericapsular infarction underwent three DTI examinations within 7 days ,30 days and 90 days after stroke symptom onset .Motor function was assessed with Fugl-Meyer scores .Three-dimensional reconstructions of corticospinal tract were performed using DTT .The relationship between corticospinal tract injury and motor function outcome at different time points was analyzed .Results 19 patients with left pericapsular infarction were divided into three types according to the ipsilateral corticospinal tract involvement on DTT .Type 2 showed the corticospinal tract located outside infarction （five cases ,FM score 96 .46 ± 7 .68）;Type Ⅱ showed less than 1/3 corticospinal tract located within the infarct or compression and tortuous （6 cases ,FM score 94 .20 ± 6 .84）;Type Ⅲ showed more than the 1/3 corticospinal tract located within the infarct （8 cases ,FM score 82 .37 ± 22.14） .The involvement of corticospinal tract was significantly negatively correlated with the FM score （ r =-0 .490 ,P=0 .033） .Follow-up DTT after 90 days ,eight patients in type Ⅲ showed 4 cases in corticospinal tract intact ,with motor function complete recovery ,2 cases in corticospinal tract regeneration ,with motor function almost complete recovery ,2 cases in corticospinal tract without regeneration ,with motor function still in severe dysfunction .Conclusion DTT could demonstrate the extent of corticospinal tract injury and its dynamic changes and greatly help the evaluation of motor function recovery in patients with cerebral infarction .