目的应用弥散张量成像(DTI)研究脑卒中后皮质脊髓束(CST)的各向异性与运动功能的关系。方法2013年1月至2016年10月,36例脑卒中患者分别在康复前及8周后行简式Fugl-Meyer评定(FMA)、金子翼上肢功能评定及DTI检查,从内囊后肢、大脑脚、脑桥三个层面,测量病灶侧CST和健侧相应部位的各向异性分数(FA),并进行相关性分析。结果康复前后,在CST 3个不同的层面上,病灶侧FA均显著低于健侧(t>5.330, P<0.001)。在内囊后肢层面上,病灶侧FA康复后提高(t=-3.415, P<0.05),在大脑脚、脑桥层面无显著性差异(t<1.653, P>0.05);健侧在三个层面上康复前后FA比较均无显著性差异(t<1.021, P>0.05)。康复前后,三个层面的FA与FMA评分、金子翼上肢功能评分均呈正相关(r>0.43, P<0.05),其中内囊后肢FA与金子翼上肢功能评分相关性较强(r=0.67)。结论DTI可用于评估脑卒中后CST损伤及其与运动功能的关系。
ObjectiveTo explore the relationship between fractional anisotropy (FA) of corticospinal tract (CST) and motor function in stroke patients using diffusion tensor imaging (DTI). MethodsFrom January, 2013 to October, 2016, 36 stroke patients were evaluated with Fugl-Meyer Assessment (FMA), Japan Upper Limb Function Test and DTI before and eight weeks after rehabilitation. FA in posterior limb of internal capsule, cerebral peduncle and pons were obtained, including ipsilesional and contralesional CST. ResultsThe FA values within three sections of CST were significantly lower in the ipsilesional side than in the contralesional side both before and after rehabilitation (t>5.330, P<0.001). In posterior limb of internal capsule, the FA value increased after rehabilitation (t=-3.415, P<0.05), and no significant difference was found in the other two sections (t<1.653, P>0.05) in the ipsilesional side, as well as in all the sections in the contralesional side (t<1.021, P>0.05). The FA values were positively correlated with the scores of FMA and Japan Upper Limb Function Test in all the sections both before and after rehabilitation (r>0.43, P<0.05), especially the relationship between the FA value and the score of Japan Upper Limb Function Test in the posterior limb of internal capsule (r=0.67). ConclusionDTI can be used to evaluate CST injury and the relationship between CST injury and motor function.
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