磁共振扩散张量成像在脑梗死中的初步应用

目的:采用MR扩散张量成像(DTI)对不同时期的脑梗死灶进行观察,探讨皮质脊髓束的受累情况与患者运动功能损害的相互关系,评价DTI对判断脑梗死的治疗效果及预后评估的价值。方法:对25例超急性或急性期脑梗死患者行DTI检查,对所得的原始数据利用纤维束后处理软件行三维皮质脊髓束图像重组,观察脑梗死灶与皮质脊髓束的关系;并对每例患者进行2次临床神经功能症状评分,作为临床评价标准。结果:25例中DTI显示8例者皮质脊髓束从梗死灶边缘通过,表现为无受压、移位、中断等,临床上患者的运动功能表现为无或轻微损害;10例显示皮质脊髓束部分从梗死灶中通过,表现为部分受压、中断,临床上患者运动功能出现受损的症状,治疗后症状部分恢复;7例皮质脊髓束全部从梗死灶中通过,表现为大部分中断、破坏,临床上患者表现为即使进行治疗,大多数运动功能无恢复或仅轻微改善。结论:通过DTI可对脑梗死治疗效果及预后评估提供重要的功能解剖学依据。

Preliminary Clinical Application of Diffusion Tensor Imaging in Cerebral Infarction

Objective:To observe the changes in different stages of cerebral infarction with diffusion tensor imaging (DTI),and to study the correlation of the major cortico-spinal tract being affected with clinically impaired motor function,as well as to evaluate the value of DTI in judging the therapeutic efficacy,and predicting the prognosis of cerebral infarction.Methods:DTI was performed in 25 patients with super-acute or acute stage of cerebral infarction.The initial data were reconstructed by 3-dimensional fiber tractography with processing software,and the relation of infarct focus and cortico-spinal tract was studied.For each patient,the clinical nerve function was scored twice at different stages and used as the criteria of clinical evaluation.Results:Of the 25 patients having DTI,there were 8 patients showing cortico-spinal tract passing along the edge of cerebral infarct,without being compressed,displaced or disrupted. There were 10 patients showing cortico-spinal tract partially passing through the edge of cerebral infarct,being partially compressed and disrupted.Clinically,these patients had no or mild motor function abnormality,showed partial recovery after treatment.Another 7 patients showed cortico-spinal tract passing through the infarct,with bulky disruption and destruction,the motor function might not be recovered or only slightly improved even though treatment was granted.Conclusion:The anatomic and functional evidence in evaluating the therapeutic efficacy and prognosis of cerebral infarct could be provided by DTI.