fMRI评价正常老年人腕关节被动运动下脑激活区

目的 用功能磁共振技术观察正常老年人双侧腕关节被动运动时脑区激活情况.方法 对30例正常的右利手老年受试者分别进行双侧腕关节被动运动的功能MR扫描,采用SPM2软件进行数据分析和脑功能区定位.结果 利手(右手)运动主要激活对侧感觉运动皮质、运动前区,双侧辅助运动区、后顶叶及同侧小脑;非利手运动时除激活上述脑区外,还激活了同侧运动感觉区和对侧小脑,且对侧运动前区、双侧辅助运动区和同侧小脑的激活体积明显大于利手腕关节运动.结论 被动运动依赖于大脑皮质和小脑等许多与运动相关的脑功能区的参与;与利手腕关节运动相比,非利手腕关节运动更依赖于对侧PMC、双侧SMA和同侧小脑等运动区.     

缺血性脑卒中患者患手主动运动及被动运动时的功能性磁共振研究

目的观察缺血性脑卒中患者患手执行主动及被动运动时的脑激活模式,探讨主动运动和被动运动治疗脑卒中后手功能障碍的中枢机制。 方法对5例左侧大脑皮质下脑卒中患者患手执行主动及被动抓握-释放动作,执行动作期间采用血氧水平依赖性功能性磁共振（BOLD-fMRI）进行脑扫描,利用SPM5软件对上述患者试验数据进行分析,使用XJVIEW toolbox 8.11版软件得出入选患者在上述两种运动状态下的脑激活区分布图,并对其在不同运动状态下的脑激活模式特点进行分析比较。 结果入选患者患手在执行主动运动时其脑激活部位主要位于对侧感觉运动区(SMC)、运动前区(PMC)、双侧小脑及双侧辅助运动区(SMA),另外同侧SMC及PMC区也有轻度激活;激活脑区主要位于对侧大脑及小脑半球。患手执行被动运动时的脑激活部位主要位于双侧SMC、PMC区、双侧小脑、SMA区;激活脑区平均分布于两侧大脑及小脑半球。与患手主动运动比较,患手被动运动时的脑区激活范围较广泛,激活强度也较高。 结论患手执行主动运动和被动运动均可激活脑卒中患者运动相关脑区,提示对脑卒中患者进行主动运动及被动运动均可促进其脑功能重组。     

功能性近红外光谱技术在利手、非利手主动抓握-释放任务下脑区激活研究中的应用

目的 探讨功能性近红外光谱技术(fNIRS)观察健康人利手、非利手复杂运动模式下双侧感觉运动区(SMC)、运动前区(PMC)激活模式中的应用价值。方法 2019年8月至12月,社区招募右利手健康人15例,采用Block设计,执行抓握-释放握力器任务,于双侧SMC、PMC和前额叶皮质行fNIRS探测,根据氧合血红蛋白和脱氧血红蛋白浓度变化观察两种运动状态下脑区激活通道及强度。结果 根据氧合血红蛋白浓度,右(利)手运动时,双侧激活通道数相同,左侧SMC激活平均β值更高(P < 0.05);左(非利)手运动时,对侧激活通道更多,右侧SMC激活平均β值更高(P < 0.05)。根据脱氧血红蛋白浓度,利手或非利手运动时,对侧激活通道更多;右(利)手运动时,左侧SMC激活平均β值更高(P < 0.05),通道12 (左侧PMC)和通道26 (右侧PMC)激活更强(P < 0.05)。结论 fNIRS可用于利手、非利手复杂运动模式下手运动相关脑区激活的研究,应更关注氧合血红蛋白浓度变化的结果。     

健康中老年人利手和非利手侧饮水动作的三维运动学研究

目的:应用三维运动采集系统分析健康中老年人利手和非利手侧上肢饮水动作的运动学特点,探讨利手和非利手执行特定功能性动作是否存在差异性。方法:用Vicon Nexus运动采集系统对18名右利手健康中老年人左右侧上肢执行饮水动作的运动轨迹进行采集,分析并比较利手和非利手侧肩、肘和腕关节的三维运动角度变化及角速度峰值。结果:肘关节X、Y、Z轴上运动角度利手和非利手侧比较差异有显著性意义(P0.05)。在角速度方面,双侧肩关节X轴上最小值、肘关节Y轴和Z轴的最大值及最小值、腕关节Y轴的最大值比较差异有显著性意义(P0.05)。结论:健康中老年人在执行饮水动作时,利手侧肘关节的屈伸幅度显著高于非利手侧;而非利手侧肘关节内收外展和内外旋运动角度及角速度显著高于利手侧。     

正常人手指简单运动时脑功能区被激活的SPECT脑血流研究

目的运用单光子发射断层扫描仪(SPECT)对比观察不同年龄组正常人执行手指简单运动时脑内不同感兴趣区(ROI)的血流量变化,以期探讨运动功能区的作用。方法健康的志愿者18例,按照年龄划分为青年组和中老年组。每一受试对象分别安静和执行手指简单运动状态下进行99mTcECDSPECT扫描脑血流量测定。结果两组间的运动频率无明显差异,但中老年组的错误率显著高于青年组。运动激活后各脑叶的局部血流量无明显变化,而对侧初级运动区(M1)、同侧小脑、双侧辅助运动区(SMA)血流量显著变化。两组间相比,中老年组的对侧M1、同侧小脑的血流量增加低于年轻组,而双侧SMA则大于青年组(P<0.05)。结论手指的简单运动主要激活对侧M1、同侧小脑、双侧SMA;中老年组的SMA激活比青年组明显,显示中、老年人通过自身代偿机制调动更多的SMA参与运动的启动与执行。     

脑卒中后偏瘫手运动功能的恢复：纵向fMRI对照

目的:观察脑卒中后偏瘫手运动功能恢复后纵向fMRI表现。方法:于2003-12/2006-02选择中山大学第二附属医院神经内科收治的脑卒中患者11例,为脑卒中组。经CT或MRI证实脑梗死、出血,病灶可以累及运动皮质、内囊、基底节或脑干。发病时患侧手握力至少减低到4-级或以下。康复期(到行fMRI时)握力恢复到4 级以上,所用康复方法不限。行fMRI检查时间分别在发病后2个月和6个月。患者均知情同意。同期选择健康体检者15例为正常对照组,均为右利手,其中7例完成双侧手运动fMRI,另8例仅完成右侧手运动fMRI。观察指标:①非量化指标:观察双侧主要感觉运动区(Primary sensorimotor cortex,SM1)的激活位置、形态、范围和分布,观察运动前区(Premotor cortex,PM)、补充运动区(Supplementary motor area,SMA)、角回运动区(Cingulate motor areas,CMA)和非运动区的激活出现率。②量化指标:测量SM1的激活体积:用感兴趣区技术测量每一层SM1区激活的面积,相加后乘以层厚。侧方指数按公式计算:侧方指数=(对侧SM1激活体积-同侧SM1激活体积)/(对侧SM1激活体积 同侧SM1激活体积)。结果:①正常对照组受试者手运动SM1区fMRI表现:激活区在中央前后回区,可在侧脑室顶以上2￣6个层面观察到。激活区的形态呈斑片或不规则状,不同个体或左右手之间不完全相同。右、左手运动的对侧SM1激活体积、同侧SM1激活体积和侧方指数相近,差异无显著性意义(P>0.05)。②正常对照组受试者手运动非主要运动区和非运动区fMRI表现:非主要感觉运动区及非运动区的激活体积明显比SM1区小,以PM激活的出现率最高,CMA激活出现率最低,其他非运动区,除颞叶、枕叶外,出现率都比较低或无出现激活。③脑卒中后偏瘫手运动SM1区fMRI表现:在脑卒中后的2个月和6个月,无论哪侧患肢运动,在双侧SM1区均表现为斑片或不规则的激活影像,与正常对照组的激活区相似。脑卒中患者梗死后2个月与6个月右、左侧患手运动对侧SM1激活体积相近;梗死后2个月右、左侧患手运动同侧SM1激活体积大于梗死后6个月;梗死后2个月右、左侧患手运动侧方指数小于梗死后6个月;差异均无显著性意义(P>0.05)。④脑卒中患者梗死后2个月:右、左侧患手运动时,对侧SM1激活体积与正常对照组接近,差异无显著性意义(P>0.05);同侧SM1激活体积明显大于正常对照组[分别为(997±704),(195±152)mm3;(1661±962),(352±399)mm3],差异有显著性意义(t=4.312,3.240,P<0.05)。右、左手侧方指数明显小于正常对照组(分别为0.258±0.679,0.853±0.104;0.042±0.553,0.726±0.299),差异有显著性意义(t=-3.405,-3.285,P<0.05)。⑤脑卒中患者梗死后6个月:右、左侧患手运动时,对侧SM1激活体积与正常对照组接近,差异无显著性意义(P>0.05);右侧患手同侧SM1激活体积明显大于正常对照组[分别为(717±915),(195±152)mm3],差异有显著性意义(t=2.201,P<0.05);左侧患手同侧SM1激活体积大于正常对照组,差异无显著性意义(P>0.05);右、左手侧方指数小于正常对照组,差异无显著性意义(P>0.05)。⑥脑卒中后偏瘫手运动非主要运动区和非运动区fMRI表现:非主要运动各区和非运动区的激活体积比SM1区小,非主要运动区梗死后2个月时双侧PM、CMA激活区出现率均高于梗死后6个月;梗死后2个月时右侧SMA激活区出现率高于梗死后6个月,左侧SMA激活区出现率低于梗死后6个月。非运动区左颞叶区、左额前区、左顶后区激活出现率稍高,丘脑、基底节出现率稍低,梗死后2个月与6个月比较总体差别不大。结论:脑卒中后康复者,其对侧SM1激活体积在早期(梗死后2个月)已趋向稳定,同侧SM1区早期仍有明显代偿现象,晚期(梗死后6个月)趋向正常。     

手运动想象对脑卒中患者脑电信号的影响

摘要 目的：分析脑卒中患者健患侧手运动想象（motor imagery, MI）时大脑前运动区（premotor area, PMA）及初级运动皮质（primary motor cortex, M1）的脑电信号特征,明确手运动想象对双侧大脑激活的影响。 方法：选取2020年1月—2021年12月于山东大学齐鲁医院康复科住院治疗的脑卒中左侧肢体偏瘫患者18例,采用左右手MI训练,随机想象左右手运动,其中,想象左手运动30次,想象右手运动30次。记录随机MI时,M1区（导联25/26/27/29/30/31）及PMA（导联16/17/18/20/21/22）脑电信号,比较MI时不同脑区激活特点。 结果：无论患手或健手MI时,随着PMA脑电信号的增强,同侧M1区相应导联的脑电信号随之增强,呈现明显正相关性（均P<0.05）。患手MI时,PMA激活明显高于M1区（P<0.05）,而健手MI对PMA和M1区激活的作用相类似（均P>0.05）。患手或健手MI时,均明显激活健侧M1区（P<0.05）,余双侧大脑对应导联之间无显著性差异（P>0.05）。 结论：本研究证明MI可同时激活PMA和M1区,而且无论是健侧或患侧MI,均明显激活健侧M1区。     

正常人三种运动任务的血氧水平依赖性磁共振脑功能成像定量分析

目的 利用全脑血氧水平依赖性磁共振脑功能成像(BOLD-fMRI)技术,探讨参与对指、握拳、被动运动的关键脑功能区.方法对10例健康右利手志愿者右手(利手)或左手(非利手)的对指、握拳、被动运动进行全脑BOLD-fMRI扫描,记录激活体积、激活强度,应用配对t检验进行定量分析.结果三种运动模式下,左手运动激活对侧感觉运动皮层(SMC)体积、强度大于右手运动(P<0.05).被动、时指运动激活对侧SMC体积、强度差异无统计学意义(P>0.05).被动、对指运动激活对侧SMC体积大于握拳运动(P<0.05).被动运动激活对侧SMC强度大于握拳运动(P<0.05).对指与握拳运动激活对侧SMC强度差异无统计学意义(P>0.05).结论脑功能区的激活情况与手运动复杂程度有关,体积、强度等定量指标进一步证实利手、非利手激活脑功能区的不对称性.恒定的被动运动(五指依次被动曲伸)任务用于BOLD-fMRI研究具有实用性、可靠性.     

脑卒中后偏瘫手运动功能恢复的功能性磁共振成像研究

目的：应用功能磁共振成像（fMRI）技术探索脑卒中后运动功能恢复的脑代偿形式和机制。方法：选择25例脑卒中患者作为患者组，其中男16例，女9例；年龄28～75岁，平均54．1岁；进行fMRI检查时间最短为发病2周，最长为60个月。同时选择15例正常人作为对照组进行fMRI检查，其中男11例，女4例，年龄35～69岁，平均48．6岁。结果：对照组双侧手分别运动时，均在对侧SM1区产生激活，12例右手运动时激活同侧SM1区（12／15），6例左手运动时激活同侧SM1区（6／7）。SM1激活区呈斑片状或不规则状高信号。各非主要运动区亦有一定比例的激活。患者组均在对侧SM1区产生激活，同侧SM1区则有22例产生激活，激活体积多数以对侧较大，LI值为正值。右侧患手对侧SM1活平均体积及LI与正常组相近，同侧SM1均激活体积大于正常组，LI小于正常组，差异有统计学意义（P〈0．05）。左侧患手的双侧SM1均激活体积及LI与正常组比较，差异均无统计学意义。PM、SMA、CMA激活的出现率有不同程度增高，以对侧明显。结论：卒中后处于康复进程中者，患手对侧SM1积已恢复到正常水平，同侧SM1有代偿现象。双侧的PM、SMA和CMA也有代偿表现。     

视觉反馈增益对力量输出影响的fMRI研究

目的 运用全脑fMRI技术研究视觉反馈增益在运动功能执行中的调节作用.方法 设计快、慢两种变化速度的力量跟踪任务,在高低不同的两种视觉反馈增益下令15名正常受试者做右手握力运动,同时接受BOLD-fMRI扫描;采用t检验分析获得不同运动状态与静息状态信号对比的脑功能图,对比观察脑皮层兴奋区的异同.结果 四种模式握力运动均可激活初级躯体感觉运动区(SMC)、双侧前运动区(PMC)、辅助运动区(SMA)、小脑、基底节(BG)和对侧后顶叶(PPC)等.随着反馈增益的提高:S1、PPC、PMC、小脑等激活强度、范围均降低,BG恰好相反;SMA激活强度提高但范围缩小,M1表现不明显.结论 视觉反馈增益对力量输出有显著影响,不同增益所激活的脑区不同.PPC、PMC、小脑、基底节等参与调节过程.     

The preparation and execution of self-initiated and externally-triggered movement: a study of event-related fMRI.

Studies of functional brain imaging in humans and single cell recordings in monkeys have generally shown preferential involvement of the medially located supplementary motor area (SMA) in self-initiated movement and the lateral premotor cortex in externally cued movement. Studies of event-related cortical potentials recorded during movement preparation, however, generally show increased cortical activity prior to self-initiated movements but little activity at early stages prior to movements that are externally cued at unpredictable times. In this study, the spatial location and relative timing of activation for self-initiated and externally triggered movements were examined using rapid event-related functional MRI. Twelve healthy right-handed subjects were imaged while performing a brief finger sequence movement (three rapid alternating button presses: index-middle-index finger) made either in response to an unpredictably timed auditory cue (between 8 to 24 s after the previous movement) or at self-paced irregular intervals. Both movement conditions involved similar strong activation of medial motor areas including the pre-SMA, SMA proper, and rostral cingulate cortex, as well as activation within contralateral primary motor, superior parietal, and insula cortex. Activation within the basal ganglia was found for self-initiated movements only, while externally triggered movements involved additional bilateral activation of primary auditory cortex. Although the level of SMA and cingulate cortex activation did not differ significantly between movement conditions, the timing of the hemodynamic response within the pre-SMA was significantly earlier for self-initiated compared with externally triggered movements. This clearly reflects involvement of the pre-SMA in early processes associated with the preparation for voluntary movement.     

脑缺血性卒中患者运动功能康复的功能性磁共振成像研究

目的利用功能性磁共振成像（fMRI）技术研究急性期缺血性脑卒中患者（以下简称急性期患者）运动相关皮质的激活情况，并探讨脑卒中后脑功能重组特点及其与肢体运动功能恢复的关系。方法采用GEI．5T双梯度16通道磁共振成像系统，对9例急性期患者和9例健康志愿者行Bold—fMRI检查。fMRI检查以被动对指运动（以下简称运动）为刺激任务，所有数据采用SPM2软件包进行离线后处理。比较健康志愿者与急性期患者fMRI结果的异同点，计算脑激活区体积和单侧化指数（LI），考察急性期患者患手运动LI值与患手运动功能的关系。结果健康志愿者单手运动激活对侧感觉运动皮质（SMC）、双侧辅助运动区（SMA）。急性期患者患手运动时同侧半球脑激话增多，健手运动的fMRI结果与健康志愿者基本一致。LI值也进一步确定，急性期患者患手运动时同侧半球脑激活增多。统计学分析表明，急性期患者患手运动的LI值与患手运动功能呈正相关。结论fMRI检查能客观地反映急性期患者运动相关皮质改变，提示存在脑功能代偿与重组。急性期患者患手运动LI值与患手运动功能呈正相关，提示fMRI是研究缺血性脑卒中后肢体运动功能康复与脑功能重组之间关系的一种有效工具。     

正常人体针灸效应功能性磁共振成像的研究

目的评价针刺体表穴位对脑部相应区域的功能性磁共振成像(fMRI)表现。方法17例健康志愿者，在1，5TMRI仪上进行针刺足三里(S36)、阳陵泉(G34)的实时动态fMRI检查，观察并分析针刺效果明显者的脑部功能变化情况，判断针刺效果及其意义。结果17例志愿者中13例检查成功，可见躯体感觉运动区(SMC)、运动前区(PMC)、副运动区(SMA)激活明显，额叶前部、扣带回、尾状核头部、豆状核及丘脑、岛叶、岛盖皮质大多有大面积明显激活，小脑和桥脑也可见有激活，在左侧丘脑、SMA、SMC、PMC激活区附近有信号减低的现象，但激活的像素数不多；信号减低区包括两侧额叶内侧面皮质，双侧扣带回前部皮质，两侧海马区，右侧眶回、基底节、尾状核头部等。结论针刺对脑部相关穴位的治疗效应显著，可产生广泛而复杂的脑功能变化，fMRI可清楚显示针刺效应引起的脑部功能变化，是针刺机制及效应良好且直观的评价途径。     

Different ipsilateral representations for distal and proximal movements in the sensorimotor cortex: activation and deactivation patterns

Each hemisphere is known to be also involved in controlling the ipsilateral arm, but with an asymmetry favoring the dominant hemisphere. However, the relative role of primary and secondary motor areas in ipsilateral control is not well defined. We used whole brain functional magnetic resonance imaging in healthy human subjects to differentiate between contributions from primary and secondary areas during discrete unilateral distal finger and proximal shoulder movements. It was found that ipsilateral distal movements activated secondary areas only, while sparing or even significantly deactivating the primary sensorimotor cortex. Ipsilateral proximal movements substantially activated both SM1 and secondary areas. A newly defined small territory within the precentral gyrus, extending from the premotor cortex and intruding toward SM1, showed an activation pattern corresponding to secondary motor areas. Finally, the effects of hemispheric dominance were confirmed, but attributed exclusively to secondary areas. These new imaging findings agree well with functional requirements as well as established anatomical and neurophysiological data.     

Central activation by histamine-induced itch: analogies to pain processing: a correlational analysis of O-15 H2O positron emission tomography studies

The aim of this study was to identify the functional cerebral network involved in the central processing of itch and to detect analogies and differences to previously identified cerebral activation patterns triggered by painful noxious stimuli. Repeated positron emission tomography regional cerebral blood flow (rCBF) measurements using O15-labeled water were performed in six healthy right-handed male subjects (mean age 32 +/- 2 years). Each subject underwent 12 sequential rCBF measurements. In all subjects a standardized skin prick test was performed on the right forearm 2 min before each rCBF measurement. For activation, histamine was applied in nine tests in logarithmically increasing concentrations from 0.03 to 8%. Three tests were performed with isotonic saline solution serving as a control condition. Itch intensity and unpleasantness were registered with a visual analogue scale during each test. Subtraction analysis between activation and control conditions as well as correlation analysis with covariates were performed. Itch induced a significant activation in the predominantly contralateral somatosensory cortex and in the ipsilateral and contralateral motor areas (supplementary motor area (SMA), premotor cortex, primary motor cortex). Additional significant activations were found in the prefrontal cortex and the cingulate gyrus, but not in subcortical structures nor in the secondary somatosensory cortex. In correlation analyses, several cortical areas showed a graded increase in rCBF with the logarithm of the histamine concentration (bilateral sensorimotor areas and cingulate cortex; contralateral insula, superior temporal cortex and prefrontal cortex) and with itch unpleasantness (contralateral sensorimotor cortex, prefrontal cortex and posterior insula; ipsilateral SMA). Induction of itch results in the activation of a distributed cerebral network. Itch and pain seem to share common pathways (a medial and a lateral processing pathway and a strong projection to the motor system). In contrast to pain activation studies, no subcortical (i.e. thalamic) activations were detected and correlation analyses suggest differences in subjective processing of the two sensations.     

运动想象治疗脑卒中患者手部运动功能的功能磁共振研究

目的：探讨运动想象（MI）治疗对脑卒中后脑功能重塑的影响。方法：将16例脑卒中患者随机分为运动想象组（MI）6例、执行运动（EM）组5例、对照组（CG）5例。3组在常规康复治疗基础上,MI组、EM组分别进行运动想象、实际动作治疗,每次30min,每周5次,为期4周。治疗前、后进行运动功能评价,并使用功能磁共振（fMRI）观察患手对指实际动作、想象时偏瘫对侧感觉运动区的激活情况,定量分析治疗前后cSMC区的激活强度t、LI变化。结果：治疗4周后,MI组及EM组FMA、STEF评分较前均有明显提高（均P＜0.05）,且MI组上述评分均更高于其它2组（均P＜0.05）。治疗后,3组MBI评分均有提高,但组内及组间差异无统计学意义。运动想象与运动执行的激活部位相似：治疗前运动想象激活区主要位于双侧SMC区、双侧SMA区,治疗后,各组双侧SMC区激活强度有增大趋势,MI组对侧SMC区激活显著（P＜0.05）,且对侧偏侧化优势较CG组显著（P＜0.05）。结论：运动想象治疗能够明显改善脑卒中后患者手功能,其机制可能与运动想象促进脑功能重塑有关。     

Altered central sensorimotor processing in patients with complex regional pain syndrome

Alterations in tactile sensitivity are common in patients with chronic pain. Recent brain imaging studies have indicated that brain areas activated by acute experimental pain partly overlap with areas processing innocuous tactile stimuli. However, the possible effect of chronic pain on central tactile processing has remained unclear. We have examined, both clinically and with whole-head magnetoencephalography, six patients suffering from complex regional pain syndrome (CRPS) of the upper limb. The cortical somatosensory responses were elicited by tactile stimuli applied to the fingertips and the reactivity of spontaneous brain oscillations was monitored as well. Tactile stimulation of the index finger elicited an initial activation at 65 ms in the contralateral SI cortex, followed by activation of the ipsi- and contralateral SII cortices at about 130 ms. The SI responses were 25-55% stronger to stimulation of the painful than the healthy side. The distance between SI representations of thumb and little finger was significantly shorter in the hemisphere contralateral than ipsilateral to the painful upper limb. In addition, reactivity of the 20-Hz motor cortex rhythm to tactile stimuli was altered in the CRPS patients, suggesting modified inhibition of the motor cortex. These results imply that chronic pain may alter central tactile and motor processing.     

卒中早期手指被动运动的脑功能磁共振成像研究

目的应用扩散张量成像及BOLD-fMRI技术观察卒中早期手指被动运动时大脑半球相关区域血氧水平的变化情况.方法采用1.5 T MR成像系统对6名早期卒中患者进行BOLD-fMRI及扩散张量成像,采用手指被动屈伸运动作为fMRI的刺激任务.结果在锥体束中断时,卒中早期健手运动时激活双侧SMC区,患手运动可激活对侧半球后顶叶皮层及同侧SMC区;锥体束较完整时健手运动时激活对侧SMC区,患手运动激活双侧SMC区、双侧后顶叶皮层.结论卒中早期可能发生运动功能通路的重构,但锥体束不同损伤情况下运动功能恢复可能存在不同的机制.DTI与fMRI联合应用将是监测和研究脑卒中后恢复的有用工具.