DTI 及 DTT在评价急性大脑中动脉供血区脑梗死患者预后中的应用

doi:10.3969/j.issn.1674-490X.2015.01.004

医学研究与教育 ›› 2015, Vol. 32 ›› Issue (1): 16-20.DOI: 10.3969/j.issn.1674-490X.2015.01.004

DTI 及 DTT在评价急性大脑中动脉供血区脑梗死患者预后中的应用

李岩¹，高娟¹，苏立凯¹，殷小平²，李会敏¹，赵永侠²，崔蕾¹ ，李伟斌¹

1. 河北大学附属医院神经内科，河北保定 071000；2. 河北大学附属医院核磁室，河北保定 071000

出版日期:2015-02-25 发布日期:2015-02-25
通讯作者: 高娟（1972—），女，河北保定人，主任医师，在读博士，硕士生导师，主要从事脑血管病研究。E-mail: gaojuzhulia@163.com。
作者简介:李岩（1985—），女，河北保定人，在读硕士，主要从事脑血管病研究。
基金资助:
河北省科学技术研究与发展计划项目（10206128D）

Application of DTI and DTT in the evaluation of prognosis in patients with acute middle cerebral artery infarction

LI Yan¹, GAO Juan¹, SU Likai¹, YIN Xiaoping², LI Huimin¹, ZHAO Yongxia², CUI Lei¹, LI Weibin¹

1. Department of Neurology, Affiliated Hospital of Hebei University, Baoding 071000, China; 2. Department of MR, Affiliated Hospital of Hebei University, Baoding 071000, China

Online:2015-02-25 Published:2015-02-25

摘要/Abstract

摘要： 目的利用核磁共振弥散张量成像（DTI）及白质纤维束成像（DTT）技术评价急性大脑中动脉供血区脑梗死患者皮质脊髓束（CST）损伤程度与预后的关系。方法对 20 例急性大脑中动脉供血区脑梗死的患者行常规 1.5T DTI 和 DTT检查，此检查均在发病 72 h 内进行。测量梗死灶区与对侧镜像区、梗死灶边缘区、双侧大脑脚的 FA 值及 ADC 值。据CST受损程度分为 3 级。对20 例患者分别行美国国立卫生研究院卒中评分（NIHSS）及简式Fug-Meye 运动功能评分（FMS）。将 CST 分级与发病 3 个月时 NIHSS 及 FMS 评分进行相关性分析，评价 CST 损伤程度与患者临床预后的相关性。结果梗死灶 FA 值及 ADC 值较健侧均有不同程度下降，差异均具有统计学意义（P<0.001），表明急性期缺血缺氧已造成病灶组织不同程度的损伤。CST 受损程度与运动功能障碍分级成高度负相关性（r=-0.843，P<0.001），即 CST 受损越严重，运动功能分级越低，运动功能障碍程度越重，预后越差。CST 受损程度与神经功能恢复情况成高度正相关性（r=0.819，P<0.001），即 CST受损越严重，神经功能评分越低，神经功能预后越差。结论 DTI 及 DTT为定量分析急性大脑中动脉供血区病灶组织及 CST 损伤程度提供了途径，为早期准确判断临床预后及指导临床治疗提供了可靠依据。

关键词: 脑梗死, 弥散张量成像, CST 重建, 运动功能预后

Abstract: Objective To investigate the correlation between different damage degrees of CST and prognosis in patients with acute middle cerebral artery infarction by using MR diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT). Methods Twenty patients with middle cerebral artery infarction were prospectively examined with 1.5T diffusion tensor imaging and diffusion tensor tractography within a 72-hour mean interval onset. The fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) in ischemic lesion and the oppsite area in nonaffected hemisphere, the fringe area of infarcts, cerebral peduncle were measured. According to the extent of CST destruction , the affacted CST was divided into three grades The twenty patients were graded by NIHSS and FMS. Spearman correlation analysis was applied to reveal the relationships between the extent of CST destruction and clinical prognosis. Results FA and ADC values notably decreased in infraction lesions verses non-affected hemisphere (P<0.001), which revealed that the tissue in infarction lesions had been damaged in different extent. Negative correlation was found between the extent of CST destruction and motor dysfunction grading according to FMS(r=-0.843, P<0.001), which revealed that the more serious CST was damaged, the lower motor dysfunction grading, the heavier degree of motor impairment, the worse prognosis. Positive correlation was found between the extent of CST destruction and recovery of neurological function according to NIHSS (r=0.819, P<0.001), which revealed that the more serious CST was damaged, the lower neurological function score, the worse prognosis of neurological function. Conclusion DTI and DTT provide a way for the quantitative analysis of acute middle cerebral artery territory lesions and the degree of CST damage, and provide reliable basis for early accurately judge the clinical prognosis and guide clinical treatment.

Key words: cerebral infarction, diffusion tensor imaging, CST reconstruction, motor function prognosis

中图分类号:

李岩，高娟，苏立凯，殷小平，李会敏，赵永侠，崔蕾，李伟斌. DTI 及 DTT在评价急性大脑中动脉供血区脑梗死患者预后中的应用[J]. 医学研究与教育, 2015, 32(1): 16-20.

LI Yan, GAO Juan, SU Likai, YIN Xiaoping, LI Huimin, ZHAO Yongxia, CUI Lei, LI Weibin. Application of DTI and DTT in the evaluation of prognosis in patients with acute middle cerebral artery infarction[J]. Medical Reserch and Education, 2015, 32(1): 16-20.

参考文献

[1] 陈胜堂, 郑晓林. FA 值在脑白质病与正常白质的对照与分析[J]. 罕少疾病杂志, 2013, 20(3): 36-39.
[2] 钟进, 张云亭. MR 扩散张量成像在急性脑梗死的临床应用[J]. 中华放射科杂志, 2005, 39(7): 677-680.
[3] 刘青蕊, 赵静, 国丽茹, 等. 磁共振弥散张量成像在脑梗死中的应用[J]. 脑与神经疾病杂志, 2011, 19(5): 345-348.
[4] SUNDGREN P C, DONG Q, G MEZ-HASSAN S, et al. Diffusion tensor imaging of the brain; Review of clinical applications[J]. Neuroradiology, 2004, 46(5): 339-350.
[5] BASSER P J, MATTIELLO J, LEBIHAN D. MR difusion tensor spectroscopy and imaging[J]. Biophys J, 1994, 66(1): 259-267.
[6] 王秋艳, 荣梅, 赵洪海. 弥散加权成像结合表观系数界定脑梗死患者缺血半暗带的价值[J]. 疑难病杂志, 2013, 12(12): 914-916.
[7] 王秀忠, 韩壮, 史万英, 等. MRI 表观弥散系数判断超急性期、急性期缺血性卒中缺血半暗带的临床应用价值[J]. 河北医药, 2013, 35(1): 72-74.
[8] 季鹏, 袁晓毅, 王全帮. ADC 在急性缺血性卒中缺血半暗带判定中的价值[J]. 中国中西医结合影像学杂志, 2013, 11(2): 116-118.
[9] 顾萍, 武茜, 葛颂. 不同部位脑梗死后华勒变性 3 例报道及文献复习[J]. 中国临床神经科学, 2013, 21(6): 665-670.
[10] THOMALLA G, GLAUCHE V, WEILLER C, et al. Time course of wallerian degeneration after ischemic stroke revealed bydiffusion tensor imaging [J]. J Neurol Neurosurg Psychiatry, 2005, 76(2): 266-268.
[11] THOMALLA G, GLAUCHE V, KOCH M A, et al. Diffuson tensor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke[J]. Neuroimage, 2004, 22(4): 1767-1774.
[12] 路阳, 洪楠, 杜湘珂. 正常人脑白质纤维结构的扩散张量成像研究[J]. 中国医刊, 2005, 40(3): 40-41.
[13] YAMADA K, ITO H, NAKAMURA H, et al. Stroke patients’ evolving symptoms assessed by tractography[J]. Magn Resonimaging, 2004, 20(6): 923-929.
[14] WONG K S, GAO S, CHAN Y L, et al. Mechanisma of acute cerebral inntarctions in patients with middle cerebral artery stenosis: a diffusion weighted imaging and microemboli moniting study[J]. Ann Neurol, 2002, 52: 74-81.
[15] LEE P H, OH S H, BANG O Y, et al. Infarct patterns in atherosclerotic middle cerebral artetry versus internal carotid artry disease[J]. Naurology, 2004, 62(8): 1291-1296.

DTI 及 DTT在评价急性大脑中动脉供血区脑梗死患者预后中的应用

Application of DTI and DTT in the evaluation of prognosis in patients with acute middle cerebral artery infarction

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