脑干梗死不同阶段梗死灶体积和ADC值的演变及其与临床预后关系的研究

目的通过对脑干梗死患者发病不同阶段的MRI随访研究，结合患者临床运动功能恢复情况，揭示梗死灶体积和表观扩散系数（ADC）值的演变规律，及其与临床症状和预后的关系。方法选择11例首次发病的脑干梗死患者，分别于发病后不同时间（〈7d、15d和1、3、6个月）测量梗死灶体积和ADC值，计算病灶与健侧相应部位的相对ADC（rADC）值；采用Fugl-Meyer运动量表（FMMS）进行临床运动功能评价，并分析梗死灶体积、rADC值与患者运动功能之间的相关关系。结果发病后脑干梗死灶体积逐渐缩小（F=4．553，P=0．003），rADC值逐渐升高（，=22．991，P=0．000），除发病7d内的脑干梗死灶体积与同期FMMS评分呈负相关关系（r=-0．686，P=0．020），其余各测量时间点脑干梗死灶体积和不同时期rADC值均与FMMs评分无相关关系（P〉0．05）。结论脑干梗死灶体积和rADC值随病程的演变呈动态变化，具有规律性，但与患者运动功能恢复情况无明显相关性。

The MRI study on the changes of lesion volume and ADC values of brainstem infarction and the correlation with clinical prognosis

Objective To explore the regular variation of lesion volume and apparent diffusion coefficient （ADC） value of brainstem infarction in different stages after stroke symptom onset, and analyse the correlation between infarction volume, ADC value and clinical prognosis. Methods Eleven patients with brainstem infarction underwent 5 magnetic resonance imaging （MRI） examinations within 7 d, 15 d, 1 month, 3 months and 6 months after symptom onset. The lesion volumes and relative ADC （rADC） values were measured in different stages of brainstem infarction. At the same time, motor deficits were assessed with Fugl-Meyer Motor Scale （FMMS） score. The difference of infarction volumes, rADC values and FMMS scores at different time points were compared. The correlation between infarction volumes, rADC values and FMMS scores was analysed, respectively. Results The infarction volumes significantly decreased progressively with time （F = 4.553, P = 0.003）, while the rADC values significantly increased progressively with time （F = 22.991, P = 0.000）. Negative correlation was seen between the lesion volume and FMMS score （r =- 0.686, P = 0.020） within 7 d, but no correlation was seen at other time points （P 〉 0.05）. There was no significant correlation between rADC values and the FMMS scores after infarction （P 〉 0.05）. Conclusion There is certain regularity in the changes of infarction volume and rADC value in patients with brainstem infarction in different stages. However, no strong correlation of early infarction size and rADC value with motor outcome is detected.