针刺改善急性脑缺血后脑白质损伤的DTI研究

目的:通过DTI评价针刺改善脑白质缺血损伤的有效性。方法:8例经DWI序列扫描证实有单侧急性脑白质梗死的患者,随机分成针刺组和无针刺组进行治疗,各4例,分别于治疗后第1、2、3个月末行常规MRI和DTI检查。DTI原始图像经后处理获得各向异性分数(fractional anisotropy,FA)、ADC和纤维示踪成像图。根据DWI图像,分别于缺血白质区域和对侧同名纤维束镜像区域取正常ROI,测量FA值和ADC值后,计算比值并进行比较。结果:治疗2个月末和3个月末,针刺组急性脑缺血患者损伤脑白质的ADC比值显著低于无针刺组(t=2.459,P=0.01;t=1.889,P=0.036)。首诊、1个月末的2组ADC和FA比值以及2个月末、3个月末2组FA比值差异无统计学意义(P>0.05),纤维示踪成像显示缺血区域脑白质较正常区域分离、稀疏、缺失。结论:DTI技术可显示针刺对急性脑缺血患者脑白质损伤的改善,其中ADC比值为主要参考指标。

A DTI study of acupuncture improving the ischemic white matter injury in the stroke patients

Objective： To evaluate the effect of acupuncture improving the ischemic white matter in the acute stroke patients by DTI. Methods：Eight acute unilateral cerebral ischemia patients underwent MRI and DTI study within 3 days after the onset of illness. Then they were randomly divided into acupuncture group and without acupuncture group with each containing 4. MRI and DTI scans were done 1,2 and 3 months after treatment. Fractional anisotropy （FA） maps, ADC maps and diffuse tensor tracking （DTT） images were obtained. With the reference of the DW images,ROI were selected on the ischemic white matter, and the control ROI were selected on the contra-lateral homonymic white matter. The ratios of FA and ADC （rFA and rADC） within these ROI were calculated and compared. Results： The rADC values of the acupuncture group were significantly lower than it of non-acupuncture group in the post-treatment 2 and 3 months （t=2. 459,P=0.01;t= 1. 889,P=0. 036）. There were no significant differences of rFA and rADC values between two groups both in the onset of the illness and the post-treatment 1 month （P〉0.05）. No differences of rFA values were found between two groups after 2 and 3 months treatment （P〉0.05）. Compared to the normal white matter tracts, DTT images showed the ischemic white matter tract were separated, sparse, and lost. Conclusion ： Our results suggest that acupuncture therapy is effective for alleviating ischemic white matter injury. They can be detected by analyzing DTI metrics of rADC values.