摘要
目的探讨扩散张量成像(diffusion tensor imaging,DTI)技术在评估穿支动脉粥样硬化性脑梗死(branch athero-matous disease,BAD)以及皮质脊髓束(corticospinal tract,CST)完整性和损害程度的价值,协助预判临床预后。材料与方法回顾性分析河南科技大学附属黄河三门峡医院2020年7月至2022年9月经临床诊断为BAD患者病例31例,根据患者的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分及徒手肌力评定(Manual Muscle Test,MMT)评分,将患者进行预测分组,分为恢复组、部分恢复组和瘫痪组;同时通过DTI获取关键感兴趣区(region of interest,ROI)白质纤维束部分各向异性分数(fractional anisotropy,FA)及CST与BAD梗死部位的相对位置(相邻、部分穿过、穿过)关系,将患者预测为恢复组(相对位置为相邻)、部分恢复组(相对位置为部分穿过)及瘫痪组(相对位置为穿过);患者在治疗后1周、2周、4周进行NIHSS评分、MMT评分,并将评估结果作为实际值。行Pearson相关分析和偏相关分析探讨FA值、CST损害程度与NIHSS及MMT评分的相关性,并采用多因素线性逐步回归分析验证其线性数量关系。结果31例患者FA图及表观扩散系数(apparent diffusion coefficient,ADC)图显示良好,结构清晰,梗死灶FA值较镜像侧相应部位正常脑组织降低,ADC值降低,t值分别为2.836、2.107,P值分别为0.015、0.010,差异有统计学意义(P<0.05)。CST重建显示良好,左右两侧显示率均为100%;纤维束重建后10例患者可见CST与梗死灶邻近但未穿过梗死灶,这部分患者预后良好,肌力恢复较快,恢复程度明显;11例患者CST部分穿过梗死灶,这部分患者预后稍差,肌力恢复稍差;10例患者CST全部穿过梗死灶,这部分患者预后差,病程长,肌力减退明显。经相关分析显示,BAD患者NIHSS评分、MMT预测评分及治疗后实际评分与患侧FA值呈正相关(P均<0.05);进一步行多因素线性逐步回归,患侧CST与BAD梗死部位的相对位置(相邻、部分穿过、穿过)关系与评分的恢复组、部分恢复组、瘫痪组存在线性回归关系。结论DTI技术能对BAD以及CST完整性进行有效评估,其评估结果与临床预测及实际预后存在高度正相关性,可为临床治疗及评估预后提供依据。
Objective:To investigate the value of diffusion tensor imaging(DTI)technology in evaluating the integrity and damage degree of perforator atherosclerotic cerebral infarction branch athero-matous disease(BAD)and corticospinal tract(CST),and to help predict clinical prognosis.Materials and Methods:A total of 31 cases of patients with BAD from July 2020 to September 2022 were analyzed.According to the National Institutes of Health Stroke Scale(NIHSS)score and Manual Muscle Test(MMT)score,the patients were divided into prediction groups(recovery group,partial recovery group and paralysis group).At the same time,the fractional anisotropy(FA)of the key region of interest(ROI)and the relative position(adjacent,partially through,through)of CST and BAD infarction site were obtained by DTI,patients were predicted as recovery(relative adjacent),partial recovery(relative partial crossing)and paralysis(relative through);NIHSS score and MMT score were performed at 1,2,and 4 weeks after treatment,and the evaluation results were taken as the actual values.Pearson correlation analysis and partial correlation analysis were performed to explore the correlation between FA value,CST extent of damage and NIHSS and MMT score,and multivariate linear stepwise regression analysis was used to verify the linear quantitative relationship.Results:The FA and apparent diffusion coefficient(ADC)images of 31 patients showed good structure and clear structure.The FA value of the infarct and the corresponding normal brain tissue on the mirror side decreased,and the ADC value decreased,t values were 2.836 and 2.107,and P values were 0.015 and 0.010,respectively,and the differences were significant(P<0.05).The reconstruction of the corticospinal tract was good,and the visualization rate of the left and right corticospinal tracts was 100%.After fiber bundle reconstruction,10 patients showed CST adjacent to the infarct but did not cross the infarct.These patients had a good prognosis,and their muscle strength recovered quickly and the recovery degree was obvious.In 11 patients,CST partially passed through the infarct.The prognosis of these patients was slightly worse,and the recovery of muscle strength was slightly worse.All the 10 patients had CST through the infarct.The prognosis of these patients was poor,the course of disease was long,and the muscle strength decreased significantly.Correlation analysis showed that NIHSS score,MMT predicted score and actual score after treatment were positively correlated with FA value of the affected side(all P<0.05).Multiple linear stepwise regression was performed.The relative position of the affected side CST and the BAD infarct site(adjacent,partially through,and through)had a linear regression relationship with the score of the recovery group,partial recovery group,and paralysis group.Conclusions:DTI technology can effectively evaluate the integrity of BAD and CST,and the evaluation results are highly positively correlated with clinical prediction and actual prognosis,which can provide a basis for clinical treatment and prognosis assessment.
作者
荆彦平
郭振安
孙留严
吴连强
王熹
荆怡玟
陈丽微
吴肖峰
薛惠元
JING Yanping;GUO Zhen'an;SUN Liuyan;WU Lianqiang;WANG Xi;JING Yiwen;CHEN Liwei;WU Xiaofeng;XUE Huiyuan(Image Center,Yellow River Sanmenxia Hospital Affiliated to Henan University of Science and Technology,Sanmenxia 472000,China;Department of Neurology,Yellow River Sanmenxia Hospital Affiliated to Henan University of Science and Technology,Sanmenxia 472000,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2023年第7期32-36,72,共6页
Chinese Journal of Magnetic Resonance Imaging
基金
中国电建集团医疗健康产业基金项目(编号:2022036)。
