脑卒中后椎体束华勒变性的功能磁共振研究

目的应用扩散张量与磁共振波谱技术,对急性脑卒中患者进行分析,探讨其反映患者病情变化的价值.方法取一侧脑卒中患者26例,健康志愿者30例.在常规扫描后再进行DTI,MRS扫描,采用NIHSS和BI评分评价患者功能,并定期复查.分析患者梗死病灶、大脑脚ADC值、FA值及MRS的代谢产物数值变化.结果 1）病灶FA值低于正常值,与NIHSS呈正相关,与BI呈负相关.脑干FA值减小,提示神经纤维出现华勒变性;2）病灶NAA下降,低于正常侧,P〈0.01;病灶侧Cr,Cho较正常侧改变不明显,P〉0.05;大脑脚NAA 1个月后降低.结论对脑卒中患者进行DTI与MRS扫描,能较早反映患者病情严重程度,还能判断预后,并指导临床康复治疗.

Application of fMRI for Detection of Wallerian Degeneration in Corticospinal Tract after Stroke

Objective To investigate the value of DTI(Diffusion Tensor Imaging) and MRS(Magnetic Resonance Spectroscopy) in acute cerebral infarction.Method 26 patients with stroke were selected as the subjects and 30 healthy volunteers were taken as the control.After the routine scan,DTI and MRS were performed on them,and they were reexamined at regular intervals.NTHSS(National Institute of Health Stroke Scale) and BT were used to evaluate their functions.Changes in values of ADC,FA,and metabolites at the infarction focus of cerebral peduncle were analyzed and compared.Results 1) The value of FA at infarction focus was lower than that the normal value and showed a negative correlation with BI,but a positive correlation with NIHSS.The value of FA in the braintem declined,indicating Wallerian degeneration of the nervous fibers.2) NAA value at infarction focus was decreased significantly compared with that of the contralateral area(P<0.01).Cr and Cho values in the focus did not change significantly compared with those in the contralateral area.NAA value in the cerebral peduncle deceasesed after one month.Conclusion The application of DTI and MRS for the patient with stroke could reflect the recovery of the patient and predicted the prognosis,which should be instructive to the clinical rehabilitation.