磁共振扩散张量纤维束成像评价脑梗死患者皮质脊髓束损伤的价值

摘要

目的：应用磁共振扩散张量成像（DTI）及扩散张量纤维束成像（DTT）评价脑梗死患者皮质脊髓束（CST）损伤程度及与运动功能预后的关系。方法前瞻性纳入脑梗死患者68例，行常规MRI、DWI、DTI检查，并应用DTT技术进行CST三维重组，于发病7 d内和3个月时测量脑梗死区及健侧相应区域白质各向异性分数（FA），采用Fugl-Meyer量表进行运动功能评分，将CST受累程度分为4级。根据治疗后Fugl-Meyer评分情况将患者分为1组（96～99分，大致恢复正常，16例）、2组（51～95分，部分恢复，34例）、3组（≤50分，恢复差，18例），采用方差分析、Pearson和Spearman相关分析，分析脑梗死区FA值及CST受累程度与运动功能恢复的关系。结果发病7 d内和3个月时3组FA的变化幅度[（0.05±0.06、0.08±0.07、0.18±0.02）、（0.11±0.02、0.21±0.06、0.39±0.03）]差异有统计学意义（7 d内F＝32.821，3个月时F＝192.372，均P＜0.05）。DTT显示CST病变侧表现为受压、变形、移位和中断。发病7 d内CST等级与患者肢体肌力呈负相关（r＝－0.682， P＜0.01），3个月复查CST等级与患者肢体肌力呈负相关（r＝－0.728，P＜0.01）。结论脑梗死患者梗死区FA值降低及CST受累程度均与运动功能预后有关。MR DTT能直观显示CST受累程度，可为早期判断脑梗死预后提供重要依据。%Objective To evaluate the relationship between the degree of corticospinal tract (CST) injury and motor function prognosis in patients with cerebral infarction using magnetic resonance diffusion tensor imaging (DTI)and diffusion tensor teactography (DTT)imaging. Methods Sixty-eight patients with cerebral infarction were selected prospectively. They underwent conventional MRI,DWI,and DTI examinations,and the DTT technique was used to perform CST 3D reconstruction. The white matter fractional anisotropy (FA)of the infarct zones and contralateral corresponding regions was measured within 7 days and at 3 months after onset. The Fugl-Meyer scale was used to perform motor function defect score. The CST involvement degrees were divided into four grades. The patients were divided into Group 1 (96-99,roughly return to normal;n=16),Group 2 (51-95,partial recovery;n=34),and Group 3 (<50,poor recovery;n=18)according to the Fugl-Meyer scale scores after treatment. The analysis of variance,Pearson,and Spearman correlation analysis were used to analyze the relationship between FA values,CST involvement degrees and motor function recovery. Results There were significant differences in the amplitude of variation of FA within 7 d (0. 05 ± 0. 06,0. 08 ± 0. 07,and 0. 18 ± 0. 02)and at 3 months after onset (0. 11 ± 0. 02,0. 21 ± 0. 06,and 0. 39 ± 0. 03)(within 7 d F=32. 821,at 3 months F=192. 372,all P<0. 05). DTT showed that the lesion sides of CST were presented as compression,deformation,displacement,and interruption. The CST grades were negatively correlated with the neurological functional rehabilitation of the patients within 7 d after onset (r= -0. 682,P <0. 01). The CST grades were negatively correlated with the neurological functional rehabilitation of the patients at 3 months (r= -0. 728,P<0. 01). Conclusion The decreased FA values in infarct areas and the degrees of CST involvement were associated with the motor function prognosis. MR DTT can directly display the degrees of CST involvement of cerebral infarction. It can provide an important basis for early identifying the prognosis of cerebral infarction.