反馈式功能性电刺激治疗对脑梗死患者上肢运动功能恢复的影响及其机制的fMRI究

目的 探讨反馈式功能性电刺激治疗对脑梗死患者上肢运动功能恢复的影响以及应用功能核磁共振成像(MRI)分析其作用机制. 方法 将自2011年8月至2012年12月在中国康复研究中心神经康复中心住院的脑梗死患者21例(一侧肢体瘫痪且偏瘫侧肢体腕背屈关节活动度大于15°及肌张力为改良Ashworth Ⅰ+级及以下的可完成部分主动运动的患者、按随机数字表法分为反馈式功能性电刺激组8例、单纯功能性电刺激组7例及常规康复治疗组6例.3组患者均进行常规神经内科药物治疗和康复治疗,其中反馈式功能性电刺激组进行反馈式功能性电刺激治疗,单纯功能性电刺激组行功能性电刺激治疗,疗程4周.分别在治疗前及治疗4周后次日进行Fugl-Meyer运动功能量表上肢部分项目及腕背伸角度评估,以及3d内应用fMRI进行脑M1区激活强度检查. 结果 (1)治疗后4周时,3组患者的Fugl-Meyer运动功能量表上肢部分项目评分及腕背伸角度较治疗前均有改善,其中反馈式功能性电刺激组、单纯功能性电刺激组差异均有统计学意义(P＜0.05);反馈式功能性电刺激组亦明显优于单纯功能性电刺激组,差异有统计学意义(P＜0.05).(2)治疗后4周时,3组患者的患侧脑M1区激活强度较治疗前均有改善,其中反馈式功能性电刺激组差异有统计学意义(P＜0.05);反馈式功能性电刺激组亦明显优于单纯功能性电刺激组,差异有统计学意义(P＜0.05). 结论 单纯功能性电刺激和反馈式功能性电刺激均有利于脑梗死后上肢运动功能的提高,并有助于脑功能的重组,且后者较前者疗效更佳.     

急性缺血性卒中患者运动皮质激活及功能重组的功能磁共振成像研究

目的探讨急性缺血性卒中患者运动皮质激活模式和功能重组改变。方法采用f MRI观察22例急性缺血性卒中患者进行对指运动任务时的运动皮质激活模式和功能重组改变,采用美国国立卫生研究院卒中量表(NIHSS)评价神经功能、Fugl-Meyer上肢评价量表(FMA-UE)评价上肢运动功能,神经电生理学监测静息运动阈值。采用Spearman秩相关分析探讨兴趣区激活强度与神经功能、运动功能和神经电生理学的相关性,动态因果模型分析对指运动时双侧大脑半球间和大脑半球内有效连接。结果急性缺血性卒中患者患侧对指运动主要表现为患侧初级运动皮质、运动前区皮质和双侧辅助运动区激活,同时伴健侧运动前区皮质、后顶叶皮质和双侧小脑半球少量激活;健侧对指运动主要表现为健侧初级运动皮质、运动前区皮质和辅助运动区激活,同时伴患侧辅助运动区、顶下小叶少量激活。患侧初级运动皮质激活强度值与神经功能(NIHSS评分)呈负相关(r_s=-0.452,P=0.035)、与上肢运动功能(FMA-UE评分)呈正相关(r_s=0.543,P=0.009),患侧感觉运动皮质激活强度值与患侧静息运动阈值呈正相关(r_s=0.718,P=0.001)。在动态因果模型所示优势模型中,双侧初级运动皮质间存在双向负性有效连接;健侧辅助运动区对健侧初级运动皮质存在负性有效连接,对患侧初级运动皮质存在正性有效连接;患侧辅助运动区对健侧辅助运动区存在正性有效连接。健侧初级运动皮质对患侧初级运动皮质的有效连接强度值与上肢运动功能(FMA-UE评分)呈负相关(r_s=-0.461,P=0.047),健侧辅助运动区对健侧初级运动皮质的有效连接强度值与上肢运动功能(FMA-UE评分)呈正相关(r_s=0.533,P=0.041)。结论f MRI结合神经功能和运动功能评价及神经电生理学监测可以有效观察急性缺血性卒中患者运动皮质激活模式和功能重组改变,为理解脑卒中运动障碍和功能重组以及进行康复治疗提供指导。     

皮层下脑梗死运动功能自发恢复的功能性近红外光学成像研究

目的 评价皮层下脑梗死患者发病后早期运动相关的脑激活部位及其与Fugl-Meyer 评分的相关性.方法 对发病后14d内的皮层下脑梗死患者和志愿者进行近红外脑功能成像检查.实验采用模块设计、抓握任务,经数据处理、统计和脑功能区定位,比较脑梗死组和对照组激活区域的差别.结果 对照组仅激活右侧大脑半球初级感觉运动皮层,脑梗死组还激活左侧初级感觉运动皮层和前额叶,激活范围较对照组广泛(P＜0.01).Oxy-Hb数据与Fugl-Meyer评分之间的相关性分析差异无统计学意义(P＞0.05).结论 脑梗死发生后早期即可出现皮层功能重组,fNIRS适用于监测卒中后运动相关的脑激活状态.     

尤瑞克林对急性缺血性卒中患者脑血流自动调节能力的影响

目的评估尤瑞克林对急性缺血性卒中患者脑血流自动调节功能的影响。方法纳入发病3 d以内的单侧颈内动脉系统缺血性卒中患者58例,随机分配至尤瑞克林组和对照组,30例对照组仅给予缺血性卒中常规药物治疗,28例尤瑞克林组在常规药物治疗基础上加用尤瑞克林0.15 PNA静脉滴注,每天一次,连续应用(8±2)d。应用经颅多普勒超声联合手指血压监测仪分别对两组患者治疗前、后的脑血流调节功能进行监测。结果尤瑞克林治疗组,治疗后患侧半球相位差显著高于治疗前水平,而健侧半球的相位差在治疗前后无统计学差异。对照组中,治疗前后患侧半球和健侧半球相位差差异均无统计学意义。结论尤瑞克林可能改善急性缺血性卒中患者患侧大脑半球的脑血流自动调节能力。     

电针刺激对术中唤醒麻醉下脑功能区病变切除后氧化应激损伤的影响

目的探讨电针对术中唤醒麻醉下脑功能区病变切除后氧化应激损伤的影响。方法选择择期行脑功能区病变切除术且需术中唤醒麻醉技术的病人100例,随机分为电针组和非电针组各50例。麻醉诱导前30 min,电针组选取两侧内关、合谷和足三里,持续电针刺激至手术结束;非电针组在对应取穴旁3 cm处给予同样电针刺激。检测两组血流动力学指标心率、平均动脉压(MAP)及氧化应激相关指标超氧化物歧化酶活性(SOD)、丙二醛(MDA)、NOX2和NOX4蛋白水平的变化。结果两组各时间点心率、MAP差异无统计学意义(P0.05)。与非电针组比较,电针组术后血浆SOD水平显著升高(P 0.01),而MDA显著下降(P 0.01),NOX2和NOX4蛋白水平亦明显降低(P 0.05)。结论电针刺激复合全麻可以有效调控唤醒麻醉下脑功能区病变切除后氧化应激损伤。     

图雷特综合征患者对指运动切换的功能磁共振研究

目的 分析图雷特综合征(TS)患者在运动切换时脑激活特点,初步探讨TS患者抽动触发的可能机制.方法 14例TS患者(TS组)和14名年龄、性别相匹配的健康志愿者(对照组),用3.0T超导磁共振扫描系统进行功能MRI扫描,对比分析在对指运动转换过程中TS患者和健康志愿者的脑激活特点.结果 两组受试者激活相同的脑区:对侧的中央前后回、对侧扣带回、对侧额叶内侧回、同侧小脑半球;激活不同的脑区:附加右手对指运动时,左侧中央前后回激活体积( cm3) TS组(8.024±0.071)大于对照组(6.480±0.026),两者差异有统计学意义(t=3.026,P＜0.01);附加左手对指运动时,TS组(6.192±0.019)右侧中央前后回的激活体积大于对照组(5.608±0.037),两者差异有统计学意义(t=2.752,P＜0.05);TS组无岛叶激活,对照组出现对侧岛叶激活;TS组出现对侧丘脑激活,而对照组无丘脑激活.结论 丘脑在TS的发病机制中具有重要的作用,岛叶、扣带回、顶叶皮质环路可能是异样感觉和抽动发作前驱不适的结构和功能基础,TS患者从静止到运动的触发启动和(或)与一种运动到另一种运动的触发启动所需要的条件功能区可能存在差异.     

神经肌肉电刺激对卒中性吞咽障碍疗效的研究

目的探讨神经肌肉电刺激对卒中性吞咽障碍患者的疗效。方法将200例吞咽功能评级5级及以下的脑卒中患者分为对照组67例和研究组133例,均给予常规药物治疗配合吞咽功能训练,研究组加用Vitalstim电刺激治疗仪。2个疗程后进行吞咽评级比较。结果研究组吞咽评级结果明显优于对照组,差异有统计学意义（P〈0.01）;加用神经肌肉电刺激治疗后,单侧大脑卒中组疗效优于双侧大脑卒中组;缺血性脑卒中组疗效优于出血性脑卒中组。结论神经肌肉电刺激疗法可明显提高卒中性吞咽障碍患者的吞咽功能,临床效果优于常规治疗。     

功能磁共振成像在脑梗死患者运动功能评价中的作用探讨

目的 利用功能磁共振成像（functional magnetic resonance imaging,fMRI）分析单侧放射冠梗死患者大脑半球的激活部位及偏侧化指数（laterality index,LI）与运动功能康复水平的关系。方法 选取12例单侧放射冠梗死的患者为卒中组,5例正常志愿者为对照组。所有入选者均进行血氧水平依赖功能磁共振成像（blood oxygenation level dependent-functional magnetic resonance imaging,BOLD-fMRI）检查,扫描设备为德国西门子3.0T磁共振扫描系统。试验采用Block设计,采取患手顺序对指任务。扫描结果采用统计参数图（Statistical Parametric Mapping,SPM2）进行数据分析和脑功能区定位,计算不同感兴趣区激活体素数目及LI。扫描结束后记录患者上肢运动功能评分（Fugl-Meyer评分,F-M评分）,分析LI与F-M评分之间的相关性。结果 与对照组相比,卒中组脑部激活范围较广泛,表现为双侧运动传导通路的激活;双侧大脑半球、初级感觉运动区（sensory motor cortex,SMC）、第一躯体运动区（M1区）LI明显减少（P=0.004,0.008,0.027）。卒中组LI（半球、SMC、M1）与F-M评分之间的相关性无统计学意义（r=0.133,P=0.618;r=0.558,P=0.059;r=0.297,P=0.348）;卒中组最强激活点位于中央前回（Precentral gyrus,PRE）患者F-M评分较高（52±22）,最强激活点位于中央后回（postcentral gyrus,POS）患者F-M评分较低（36±27）,以上两组F-M评分之间差异无统计学意义（P>0.05）。结论 fMRI可以显示卒中患者运动康复过程中功能区的变化;单侧放射冠脑梗死后,与运动任务相关的脑区激活范围存在明显偏侧化现象;偏侧化程度与患者上肢运动功能之间可能无明显关系。     

高压氧治疗对缺血性卒中患者ACA-IgG及TM水平的影响

目的 探讨高压氧治疗对缺血性卒中患者抗心磷脂抗体(ACA-IgG)及血栓调节蛋白(TM)水平的影响及其临床作用. 方法 选择广州医学院第二附属医院神经内科自2009年9月至2010年9月收治的缺血性卒中患者100例,根据TOAST分型分为3组:动脉粥样硬化血栓型组(A组)、心源性栓塞型组(B组)及小动脉病变型组(C组),依照缺血性卒中药物治疗指南采用单纯药物治疗或在其基础上联合高压氧治疗.在治疗前后应用斯堪的纳维亚卒中量表(SSS)进行神经功能缺损评分.另选择同期门诊体检健康自愿者50例做为健康对照组,采用ELISA法在治疗前后检测各组对象外周血ACA-IgG及TM水平. 结果 A、B、C组患者治疗前ACA-IgG结合指数及TM水平均较健康对照组明显增高,差异均有统计学意义(P＜0.05)；B组治疗前ACA-IgG结合指数及TM水平较A、C组增高,差异均有统计学意义(P＜0.05).A、B、C组中联合高压氧治疗的患者SSS评分、ACA-IgG结合指数及TM水平均较单纯药物治疗患者明显降低,差异均有统计学意义(P＜0.05)；而分别在各组患者间比较差异无统计学意义(P＞0.05). 结论 高压氧能够通过影响与凝血功能相关的ACA-IgG结合指数及TM水平,从而改善缺血性卒中患者的临床神经功能缺损程度,利于患者的神经功能康复.但针对不同病因所致的缺血性改变其效果无明显差异.     

书写痉挛脑功能磁共振成像研究

目的 应用脑功能磁共振成像（fMRI）技术,观察书写痉挛患者痉挛性书写脑功能区激活特点,探讨书写痉挛可能发病机制.方法 采用fMRI组块设计,分别获得10例书写痉挛患者和10名年龄、性别匹配健康对照组执行默写、手写、笔写任务时的平均脑功能激活图,同时通过一般线性分析法产生“笔写减手写”及“笔写减默写”的差异脑功能图.结果 书写痉挛患者进行书写任务时,受累手对侧基底节区,特别是壳核（激活体素个数864）,较健康对照组（激活体素个数54）显著激活;运动皮质（第一运动区、辅助运动区、运动前区）及同侧小脑较健康对照亦有明显激活;而进行手指写和默写任务时两组间差异并不明显;＂笔写减手写＂及＂笔写减默写＂差异脑功能图发现书写痉挛患者在除去手指写运动及语言处理相关影响后上述脑区仍有明显激活,健康对照组则皮质下结构激活消失,运动相关皮质激活亦明显减少.结论 书写痉挛患者执行笔写任务时上述脑区尤其皮质下结构异常激活与书写痉挛发生存在一定关联,基底节区及相应皮质-皮质下环路功能紊乱,可能在书写痉挛发病机制中起到重要作用.     

Functional neuroanatomical investigation of vision-related acupuncture point specificity--a multisession fMRI study

The concept that specific acupuncture points have salubrious effects on distant target organ systems is a salient feature of Traditional Chinese Medicine (TCM). In this study, we used a multiple-session experiment to test whether electroacupuncture stimulation at two TCM vision-related acupoints, UB 60 and GB 37, located on the leg, could produce fMRI signal changes in the occipital regions of the brain, and the specificity of this effect when compared with stimulation at an adjacent non-acupoint (NAP). Six normal, acupuncture naive subjects completed the study. Each subject participated in six identical scanning sessions. Voxelwise group analysis showed that electroacupuncture stimulation at both vision-related acupoints and the NAP produced modest, comparable fMRI signal decreases in the occipital cortex, including the bilateral cuneus, calcarine fissure and surrounding areas, lingual gyrus, and lateral occipital gyrus. Further analysis of fMRI signal changes in occipital cortex showed no significant difference among the three points, UB 60, GB 37, and NAP. Our results thus do not support the view that acupuncture stimulation at vision-related acupoints induces specific fMRI blood oxygen level dependent (BOLD) signal changes in the occipital cortex. We speculate that cross modal inhibition, produced by needling-evoked somatosensory stimulation, may account for our finding of BOLD signal decreases in the occipital cortex. Given the complexity of acupuncture systems and brain activity, additional work is required to determine whether functional neuroanatomical correlates of acupoint specificity can be validated by means of brain imaging tools.     

Activation of non-primary motor areas during a complex finger movement task revealed by functional magnetic resonance imaging

We examined the brain activation induced by a complex finger movement task using functional magnetic resonance imaging (fMRI) with echo planar imaging (EPI). Imaging planes were set up for the observation of non-primary motor areas. Among five normal males examined, four subjects naive to the task showed activations in contralateral primary and supplementary motor areas and the ipsilateral superior anterior part of the cerebellar hemisphere. Also, the bilateral premotor areas and the contralateral ventrolateral nucleus of thalamus were occasionally activated. No changes were observed in the putamen and globus pallidus. The subject accustomed to the task showed activation in the narrow areas of the contralateral primary motor and supplementary motor and premotor areas but not in the cerebellum. These results suggest that fMRI has nearly the same degree of detectability to that of positron emission tomography (PET) in regard to motor functions.     

Motor representation in patients rapidly recovering after stroke: a functional magnetic resonance imaging and transcranial magnetic stimulation study

OBJECTIVE: Neuroimaging studies have suggested an evolution of the brain activation pattern in the course of motor recovery after stroke. Initially poor motor performance is correlated with an recruitment of the uninjured hemisphere that continuously vanished until a nearly normal (contralateral) activation pattern is achieved and motor performance is good. Here we were interested in the early brain activation pattern in patients who showed a good and rapid recovery after stroke. METHODS: Ten patients with first-ever ischemic stroke affecting motor areas had to perform self-paced simple or more complex movements with the affected or the unaffected hand during functional magnetic resonance imaging (fMRI). The location and number of activated voxels above threshold were determined. To study possible changes in the cortical motor output map the amplitude of the motor evoked potentials (MEP) and the extent of the excitable area were determined using transcranial magnetic stimulation (TMS). RESULTS: The pattern of activation observed with movements of the affected and the unaffected hand was similar. In the simple motor task significant (P<0.05) increases were found in the primary motor cortex ipsilateral to the movement, the supplementary motor area and the cerebellar hemisphere contralateral to the movement during performance with the affected hand compared to movements with the unaffected hand. When comparing simple with more complex movements performed with either the affected or the unaffected hand, a further tendency to increased activation in motor areas was observed. The amplitude of MEPs obtained from the affected hemisphere was smaller and the extent of cortical output maps was decreased compared to the unaffected hemisphere; but none of the patients showed MEPs at the affected hand when the ipsilateral unaffected motor cortex was stimulated. CONCLUSIONS: Despite a rapid and nearly complete motor recovery the brain activation pattern was associated with increased activity in (bilateral) motor areas as revealed with fMRI. TMS revealed impaired motor output properties, but failed to demonstrate ipsilateral motor pathways. Successful recovery in our patients may therefore rely on the increased bilateral activation of existing motor networks spared by the injury.     

Spike topography and functional magnetic resonance imaging (fMRI) in benign rolandic epilepsy with spikes evoked by tapping stimulation

We performed a spike topography study and a functional magnetic resonance imaging (fMRI) in a female patient with benign rolandic epilepsy presenting single high-amplitude evoked spikes in response to somatosensory peripheral stimulation. The stimulus was delivered to the first finger of the right hand using a tendon hammer, which evoked a single spike followed by a slow wave, showing the maximal amplitude over the left central regions. fMRI showed that the contralateral sensory cortices (S1 and S2) and the motor cortex (M I) were activated during tapping stimulation. In 3 normal subjects, tapping stimulation produced no fMRl activation. This fMRI study documents a highly focal activation of sensorimotor areas related to subclinical evoked spikes in benign rolandic epilepsy.     

Anatomical Functional Changes in a Patient Presenting a Complex Malformation of Cortical Development

The authors describe a case of right fronto‐parietal micropoligyria associated with small schizencephaly clefts and the presence of a frontal open‐lip schizencephaly with corpus callosum agenesis. A functional magnetic resonance imaging (fMRI) study was performed to evaluate the possible reorganization of cortical functions in a patient presentinga complex malformation pattern and to investigate which cortical areas were activated during left finger movements. An fMRI study was performed during the execution of a repetitive index finger‐to‐thumb opposition movement with the right hand and the left hand in 2 separate sessions. Movement of the right hand induced a normal motor activation pattern involving the contralateral left sensory‐motor cortex. Movement of the left hand produced significant activation of brain cortex. This fMRI study highlights the compensatory role of the ipsilateral cortical pathways in hand movements in the case of a complex brain malformation that involves the main motor activation areas.     

Changes in serial optical topography and TMS during task performance after constraint-induced movement therapy in stroke: a case study

The authors examined serial changes in optical topography in a stroke patient performing a functional task, as well as clinical and physiologic measures while undergoing constraint-induced therapy (CIT). A 73-year-old right hemiparetic patient, who had a subcortical stroke 4 months previously, received 2 weeks of CIT. During the therapy, daily optical topography imaging using near-infrared light was measured serially while the participant performed a functional key-turning task. Clinical outcome measures included the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and functional key grip test. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) were also used to map cortical areas and hemodynamic brain responses, respectively. Optical topography measurement showed an overall decrease in oxy-hemoglobin concentration in both hemispheres as therapy progressed and the laterality index increased toward the contralateral hemisphere. An increased TMS motor map area was observed in the contralateral cortex following treatment. Posttreatment fMRI showed bilateral primary motor cortex activation, although slightly greater in the contralateral hemisphere, during affected hand movement. Clinical scores revealed marked improvement in functional activities. In one patient who suffered a stroke, 2 weeks of CIT led to improved function and cortical reorganization in the hemisphere contralateral to the affected hand.     

简易精神状态量表和蒙特利尔认知评测量表对急性期缺血性脑血管病患者认知功能障碍筛查能力的比较研究

目的 比较简易精神状态量表（Mini-Mental State Examination,MMSE）和蒙特利尔认知评测量表（Montreal Cognitive Assessment,MoCA）对急性期缺血性脑血管病患者认知功能障碍的筛查能力。方法 对筛选的107例发病7 d内的短暂性脑缺血发作（transient ischemic attack,TIA）或脑梗死患者应用MMSE及MoCA量表进行认知功能障碍的评测,比较经两量表评测筛查出认知障碍患者的比例。根据患者教育程度对应的MMSE临界值筛选出MMSE评分在正常范围的患者,以MoCA量表评分26分为临界值将受试者分为MoCA评测正常组与异常组,比较两组在各个认知领域的得分。结果 107例患者MMSE平均分25.89±3.65分,MoCA平均分20.67±4.56分。MMSE评测异常者8例（7.5%）,正常者99例（92.5%）。MoCA评测异常者98例（91.6%）,正常者9例（8.4%）。MoCA评测正常者MMSE评测均正常。MMSE评测正常的99例患者中,MoCA评测正常者9例（9.1％,9/99）,评测异常者（<26分）90例（90.9％,90/99）。MoCA评测异常组在视空间与执行能力、命名、延迟记忆等认知领域得分低于MoCA评测正常组（P＜0.05）。结论 MoCA量表在筛查急性缺血性脑血管病患者认知障碍方面可能比MMSE量表更敏感,MMSE正常MoCA评测异常的患者认知损害主要表现在视空间执行功能、命名、延迟记忆等方面。     

Measurements of BOLD/CBV ratio show altered fMRI hemodynamics during stroke recovery in rats.

Brain responses to external stimuli after permanent and transient ischemic insults have been documented using cerebral blood volume weighted (CBVw) functional magnetic resonance imaging (fMRI) in correlation with tissue damage and neurological recovery. Here, we extend our previous studies of stroke recovery in rat models of focal cerebral ischemia by comparing blood oxygen level-dependent (BOLD) and cerebral blood volume (CBV) changes. Responses to forepaw stimulation were measured in normal rats (n=5) and stroke rats subjected to 2 h of middle cerebral artery occlusion (n=6). Functional magnetic resonance imaging was performed 2 weeks after stroke to evaluate the recovery process. After stroke, animals showed variable degrees of fMRI activation in ipsilesional cortex, the extent of which did not correlate with structural damages as measured using apparent diffusion coefficient, fractional anisotropy, blood volume, and vessel size index. While the contralesional cortex showed good overlap between BOLD and CBV-activated regions, the ipsilesional cortex showed low covariance between significantly activated voxels by BOLD and CBVw techniques. In particular, the relative activation during contralateral stimuli in the ipsilesional somatosensory cortex was significantly higher for CBVw responses than BOLD, which might be due to stroke-related alterations in fMRI hemodynamic coupling. Aberrant subcortical activations were also observed. When unaffected forelimbs were stimulated, strong bilateral responses were observed. However, little thalamic responses accompanied stimulation of affected forelimbs despite significant activation in the ipsilesional somatosensory cortex. These results suggest that stroke affects not only local hemodynamics and coupling but also other factors including neural connectivity.     

3D重建脑表面中央前回辨识及初级皮层运动功能分布研究

目的研究利用三维重建脑表面成像辨识中央前回的方法及其可靠性。方法难治性癫痫经术前评估需要进行颅内电极植入的病例12例,术前行3T磁共振结构像扫描及运动功能磁共振测试,颅内电极植入后行头颅CT扫描。利用磁共振数据,用Brainvoige软件进行脑表面三维重建,并与硬膜下电极CT融合。根据中央前回的形状走行特点,在重建的脑表面上标记中央前回,进而辨识标记术区中央前回。用皮层电刺激和功能磁共振验证所标记中央前回的可靠性。结果 12例均进行了脑表面三维重建,并标记出了中央前回,硬膜下电极CT电极点与三维脑表面融合。统计中央前回上电极点101个,电刺激运动响应73个,响应率72%;对照组中央前回前1cm（统计中央前沟前2个电极范围）,130个电极,17个电极有运动响应,响应率13%,p值小于0.05;功能磁共振手的运动100%中央前回有激活,中央前回前无明显激活。电刺激及功能核磁均验证了本研究方法确定中央前回准确可靠。结论脑表面成像辨识中央前回准确可行,可以利用各初级运动皮层分布的距离进行详细的初级运动皮层的绘制定位。     

CT脑灌注与血管造影在急性缺血性脑卒中的临床应用与分析

目的探讨CT脑灌注(CTPI)与血管造影在急性缺血性脑卒中中的临床应用价值。方法选择29例急性缺血性脑卒中患者为研究对象,采用东芝Aquilion 64排CT行头颈部CTA及CTPI检查,观察两者对急性缺血性脑卒中诊断情况,分析CTPI与CTA对急性缺血性脑卒中诊断的一致性。结果①29例患者CT灌注图上发现与临床症状相对应的灌注异常区共25例,阳性率为86.2%(25/29),高于普通CT扫描的27.6%(8/29),差异具有统计学意义(P0.05)。②灌注异常区的CBF、CBV、MTT三组参数值与镜像健侧相比差异有显著统计学意义(P0.05);③CTA血管检查结果发现单纯颈内动脉狭窄5处;单纯颅内动脉狭窄10处;颈内动脉及颅内动脉均狭窄4例。④病例组CTPI联合CTA检查结果比较,病例组存在责任血管的患者CTPI检查阳性率为65.51%(19/29)高于无责任血管者的20.69%(6/29),差异具有统计学意义(P0.05)。结论 CTPI与CTA可以清晰的显示缺血性脑卒中脑内病灶及责任动脉,能够提高更多有价值的信息。