核磁共振弥散张量纤维素成像对脑血管病患者预后的判定

目的观察急性脑血管病患者皮质脊髓束的损伤状况,分析运动功能变化并对临床预后进行判定。方法对18例脑卒中患者(其中脑梗死患者16例,脑出血患者2例)进行磁共振弥散张量纤维素成像(DTI)检查纤维束的连续性及破坏情况。于患者入院时、发病后2周、1月及2月分别进行肌力判定和神经功能评分。结果皮质脊髓束受累情况分为2级,1级:皮质脊髓束完整,共5例;2级:皮质脊髓束中断,共13例。16例脑梗死患者不同时期肌力及NIHSS评分与皮质脊髓束级别明显相关(P<0.05),发病后2月NIHSS评分转归情况与皮质脊髓束级别有显著性差异(P=0.0202)。2例脑出血患者入院时肌力均为0级但DTI显示皮质脊髓束完整的其预后也较好。18例受试者均进入结果分析,不同时期NIHSS评分与皮质脊髓束级别明显相关(P<0.05),发病后2月NIHSS评分转归情况与皮质脊髓束级别有显著性差异(P=0.0269)。结论三维纤维束示踪成像图可以更立体直观的显示皮质脊髓束状况,并在脑血管病初期即可对其损伤情况进行判定,同时可以提示脑血管病患者的预后。

Diffusion tensor tractography in prognostic evaluation of patients with cerebral vascular disease

Objective To observe the impairment of corticospinales in the acute cerebrovascular events,and analyze the changes of motor function for the prognostic judging.Methods 18 patients were tested by the diffusion tensor tractography(16 ischemic stroke,2 hemorrhagic stroke),to detect the succession and impairment of tractus.We also graded the muscle strength and scored the nervous system function at the stage of onset,2 weeks after the onset,1 month later and 2 months later.Results There were 2 grades on the condition of the injured CST.5 cases were evaluated as Grade 1,whose CST were integrity.13 cases were Grade 2 because of the discontinuance of CST.Injured degree of CST in 16 patients with ischemic stroke was significantly associated with hemiplegia muscle strength and NIHSS score(P<0.05),the turnover of the NIHSS score at two month after onset showed significant difference with the injury degree of the CST(P=0.0202).The muscle strength of the patients with hemorrhage had complete CST recovery more quickly,and the NIHSS scores at different stages were lower,though their paralysis were complete.Injured degree of CST was significantly associated with hemiplegia muscle strength and the NIHSS scores at different stages(at the stage of onset,a month after onset,two month after onset,P<0.05).The turnover of NIHSS scores at the time of 2 months after onset had significant statistic variance with the grade of the injured CST(P=0.0269).Conclusion The 3D images presented by the tractography of diffusion tensor imaging can describe the profile of CST more clearly and directly,which can be used to evaluate the impairment of CST at the early stage of acute cerebrovascular events,favoring the prognostic judgment in the rehabilitative therapy of cerebrovascular disorders.