应用扩散张量成像技术对急性缺血性卒中机体功能障碍与锥体束损伤程度的相关性研究

目的应用扩散张量成像技术(diffusion tensor imaging,DTI)研究急性缺血性卒中机体功能障碍与锥体束损伤程度的相关性。材料与方法收集急性缺血性脑卒中患者在发病急性期内的常规MRI平扫、扩散加权成像、DTI检查、工作站自动生成各向异性指数(fractional anisotropy,FA)图及ADC图,从中筛选出病变累及单侧基底节区的急性缺血性脑卒中患者16例,分别测量病灶区与大脑对侧相应部位的FA值、ADC值、纤维束数量,并计算出纤维束数量健侧与患侧差值,使用mimics软件对病灶体积进行测量,同时使用美国国立卫生研究院卒中量表(NIH Stroke Scale,NIHSS)、临床医学肌力分级对机体功能障碍程度进行评价。使用统计学方法研究健、患侧纤维束数量、FA值、ADC值的差异;统计出数量差值与病灶体积、NIHSS评分、肌力评分的相关性;统计16例患者出现的所有神经系统阳性表现。通过扩散张量纤维束成像(diffusion tensor tractography,DTT)和3D slicer软件在病变区和健侧对应部位重建,对比观察纤维束的形态变化。结果健、患侧锥体束数量、FA和ADC配对t检验有统计学差异(P<0.05,分别为0.001、0.005、0.001)。纤维束数量差值和病灶体积、肌力分级有显著相关关系(r=0.632,P=0.009;r=-0.554,P=0.026);病灶体积和NIHSS评分有显著正相关关系,差异及相关性有统计学意义(r=0.789,P=0.000)。健、患侧纤维束数量差值和NIHSS评分无相关性(P=0.061),FA值减少程度和ADC减少程度无相关性(P=0.890)。患侧纤维束走形异于健侧,部分患侧纤维束受压、变形、移位、断裂,部分健侧纤维束向患侧延伸。结论急性缺血性脑卒中患者机体功能障碍与锥体束损伤程度有相关性,病灶体积越大,锥体束损伤程度越严重,脑组织损伤程度越重,机体功能障碍程度越明显。

Study on the correlation between body dysfunction and the degree of pyramidal tract injury in acute ischemic stroke by using diffusion tensor imaging technology

Objective:To study the correlation between body dysfunction and pyramidal tract injury in acute ischemic stroke by using diffusion tensor imaging technology.Materials and Methods:Collect routine MRI scans,DWI,DTI examinations,fractional anisotropy maps(FA maps)and ADC maps generated from workstations automatically for patients with acute ischemic stroke during the acute phase of the disease.We selected 16 cases that the lesion just invade unilateral basal ganglia from acute ischemic stroke patients.Measure the FA values,ADC values,and fiber bundle numbers of the lesion area and the corresponding part of the opposite side of the brain,and calculate the difference between the healthy side and the affected side of the fiber bundle numbers.Use the Mimics software to measure the lesion volume,and use the national institutes of health stroke scale(NIH Stroke Scale,NIHSS),clinical medical muscle grading to evaluate the degree of functional impairment.Use statistical methods to study the differences in the number of fiber bundles,FA values,and ADC values on the affected side and the normal side;to calculate the correlation between the differences in fiber bundle numbers and the lesion volume,NIHSS score,and muscle strength score,to count all the positive manifestations of the nervous system in 16 patients.Diffusion tensor tractography(DTT)and 3D slicer software were used to reconstruct the fiber bundles of the lesions and the corresponding parts on the healthy side,and the morphological changes of the fiber bundles were compared and observed.Results:There was a statistically significant difference between the number of pyramidal tracts,FA and ADC on the affected side and the same part on the normal side by using paired t test(P<0.05,0.001,0.005,0.001,respectively).There was a significant correlation between the difference in the number of fiber bundles and the lesion volume and muscle strength grade(r=0.632,P=0.009;r=-0.554,P=0.026),and there was a significant positive correlation between the lesion volume and NIHSS score(r=0.789,P=0.000).And the difference and correlation were statistically significant.There was no correlation between the difference in the number of healthy and affected side fiber bundles and NIHSS score(P=0.061),and there was no correlation between the degree of reduction in FA value and the degree of reduction in ADC volume(P=0.890).The shape of the affected fiber bundle was different from that of the healthy side.Some of the affected fiber bundles are compressed,deformed displaced,and broken,and some of the fiber bundles on the normal side extend toward the affected side.Conclusions:In patients with acute ischemic stroke,there was a correlation between body dysfunction and the degree of vertebral tract injury.The larger the lesion volume,the more severe the pyramidal tract injury was,the more severe the degree of brain tissue damage was,and the more obvious the body dysfunction was.