磁共振成像
磁共振成像
자공진성상
Chinese Journal of Magnetic Resonance Imaging
2015年
10期
727-733
,共7页
杨烁慧%詹松华%陆方%李晨%林江
楊爍慧%詹鬆華%陸方%李晨%林江
양삭혜%첨송화%륙방%리신%림강
弥散磁共振成像%中风%脑缺血%脑白质病%白质纤维束损伤
瀰散磁共振成像%中風%腦缺血%腦白質病%白質纖維束損傷
미산자공진성상%중풍%뇌결혈%뇌백질병%백질섬유속손상
Diffusion magnetic resonance imaging%Stroke%Brain ischemia%Leukoencephalopathies%White matter fiber tract injury
目的：通过扩散张量成像(diffusion tensor imaging，DTI)评价急性缺血性中风患者脑白质纤维束的扩散性与神经功能恢复的相关性，预测患者运动功能的恢复情况。材料与方法40例临床诊断并经磁共振扫描证实有单侧急性脑白质梗塞并有运动功能障碍患者行DTI检查后，于治疗后1个月、2个月及3个月末行常规MRI和DTI检查，获得部分各向异性指数(FA)和表观扩散系数(ADC)。分别于缺血白质区域和对侧同名纤维束镜像区域取感兴趣区，测量FA值、A D C值后计算比值(rFA和rADC)以及梗塞体积，观察其与美国国立卫生研究院脑中风评分(NIHSS)的相关性。其中32名1年后随访到的患者，根据其运动力指数(MI)，分成恢复良好组和恢复不良组，运用rFA和rADC判断运动功能的恢复情况。结果 rFA、rADC和梗塞体积于首诊、治疗1个月末、2个月末和3个月末之间均存在统计学差异(F=13.84，P=0.00，F=64.57，P=0.00和F=37.41，P=0.00)。首诊和1个月末rFA与NIHSS评分显著负相关(r=－0.59，t=－4.59，P=0.00和r=－0.34，t=－2.27，P=0.02)；首诊rADC与NIHSS评分显著负相关(r=－0.44，t=－3.04，P=0.00)，1个月末、2个月末、3个月末rADC与NIHSS评分显著正相关(r=0.28，t=1.83，P=0.04；r=0.39，t=2.69，P=0.00；r=0.63，t=4.99，P=0.00)。1月个末、2个月末、3个月末梗塞体积与NIHSS评分显著正相关(r=0.40， t=2.73，P=0.01；r=0.44，t=3.05，P=0.00；r=0.32，t=2.13，P=0.04)。多元回归分析显示首诊rFA和3个月末rADC与患者1年后的MI有显著相关性(t=2.95， P=0.00和t=2.75，P=0.01)，3个月末rADC的ROC曲线峰下面积为0.905。结论 DTI技术能显示急性脑缺血患者脑白质纤维束损伤治疗后的演变，其测定参数与神经功能恢复有一定相关性，3个月末ADC值或可用于预测患者运动功能恢复情况。
目的：通過擴散張量成像(diffusion tensor imaging，DTI)評價急性缺血性中風患者腦白質纖維束的擴散性與神經功能恢複的相關性，預測患者運動功能的恢複情況。材料與方法40例臨床診斷併經磁共振掃描證實有單側急性腦白質梗塞併有運動功能障礙患者行DTI檢查後，于治療後1箇月、2箇月及3箇月末行常規MRI和DTI檢查，穫得部分各嚮異性指數(FA)和錶觀擴散繫數(ADC)。分彆于缺血白質區域和對側同名纖維束鏡像區域取感興趣區，測量FA值、A D C值後計算比值(rFA和rADC)以及梗塞體積，觀察其與美國國立衛生研究院腦中風評分(NIHSS)的相關性。其中32名1年後隨訪到的患者，根據其運動力指數(MI)，分成恢複良好組和恢複不良組，運用rFA和rADC判斷運動功能的恢複情況。結果 rFA、rADC和梗塞體積于首診、治療1箇月末、2箇月末和3箇月末之間均存在統計學差異(F=13.84，P=0.00，F=64.57，P=0.00和F=37.41，P=0.00)。首診和1箇月末rFA與NIHSS評分顯著負相關(r=－0.59，t=－4.59，P=0.00和r=－0.34，t=－2.27，P=0.02)；首診rADC與NIHSS評分顯著負相關(r=－0.44，t=－3.04，P=0.00)，1箇月末、2箇月末、3箇月末rADC與NIHSS評分顯著正相關(r=0.28，t=1.83，P=0.04；r=0.39，t=2.69，P=0.00；r=0.63，t=4.99，P=0.00)。1月箇末、2箇月末、3箇月末梗塞體積與NIHSS評分顯著正相關(r=0.40， t=2.73，P=0.01；r=0.44，t=3.05，P=0.00；r=0.32，t=2.13，P=0.04)。多元迴歸分析顯示首診rFA和3箇月末rADC與患者1年後的MI有顯著相關性(t=2.95， P=0.00和t=2.75，P=0.01)，3箇月末rADC的ROC麯線峰下麵積為0.905。結論 DTI技術能顯示急性腦缺血患者腦白質纖維束損傷治療後的縯變，其測定參數與神經功能恢複有一定相關性，3箇月末ADC值或可用于預測患者運動功能恢複情況。
목적：통과확산장량성상(diffusion tensor imaging，DTI)평개급성결혈성중풍환자뇌백질섬유속적확산성여신경공능회복적상관성，예측환자운동공능적회복정황。재료여방법40례림상진단병경자공진소묘증실유단측급성뇌백질경새병유운동공능장애환자행DTI검사후，우치료후1개월、2개월급3개월말행상규MRI화DTI검사，획득부분각향이성지수(FA)화표관확산계수(ADC)。분별우결혈백질구역화대측동명섬유속경상구역취감흥취구，측량FA치、A D C치후계산비치(rFA화rADC)이급경새체적，관찰기여미국국립위생연구원뇌중풍평분(NIHSS)적상관성。기중32명1년후수방도적환자，근거기운동력지수(MI)，분성회복량호조화회복불량조，운용rFA화rADC판단운동공능적회복정황。결과 rFA、rADC화경새체적우수진、치료1개월말、2개월말화3개월말지간균존재통계학차이(F=13.84，P=0.00，F=64.57，P=0.00화F=37.41，P=0.00)。수진화1개월말rFA여NIHSS평분현저부상관(r=－0.59，t=－4.59，P=0.00화r=－0.34，t=－2.27，P=0.02)；수진rADC여NIHSS평분현저부상관(r=－0.44，t=－3.04，P=0.00)，1개월말、2개월말、3개월말rADC여NIHSS평분현저정상관(r=0.28，t=1.83，P=0.04；r=0.39，t=2.69，P=0.00；r=0.63，t=4.99，P=0.00)。1월개말、2개월말、3개월말경새체적여NIHSS평분현저정상관(r=0.40， t=2.73，P=0.01；r=0.44，t=3.05，P=0.00；r=0.32，t=2.13，P=0.04)。다원회귀분석현시수진rFA화3개월말rADC여환자1년후적MI유현저상관성(t=2.95， P=0.00화t=2.75，P=0.01)，3개월말rADC적ROC곡선봉하면적위0.905。결론 DTI기술능현시급성뇌결혈환자뇌백질섬유속손상치료후적연변，기측정삼수여신경공능회복유일정상관성，3개월말ADC치혹가용우예측환자운동공능회복정황。
Objective:To evaluate the correlation between diffusivity of ischemic white matter ifber tract and neuro-functional recovery in acute stroke patients by using DTI, and try to predict the motor outcome of these patients. Materials and Methods:Forty unilateral cerebral ischemic patients with motor dysfunction underwent MRI and DTI study within three days after the onset of illness. MRI and DTI scans were done one, two and three month after treatment. Fractional anisotropy (FA) and apparent diffusion coefifcient (ADC) maps were obtained. With the reference of DW images,regions of interest (ROIs) were selected on the ischemic white matter ifber tract, and the control ROIs were selected on the contra-lateral homonymic white matter ifber tract. The ratios of FA and ADC (rFA and rADC) within these ROIs and infarction volume were calculated. The relationship between DTI parameters with infarction volume and national institute of health stroke scale (NIHSS) scores were assessed. According to motricity index (MI), a total of thirty-two stroke follow-up patients after one year treatment were divided into no motor deifcit group and motor deifcit group and DTI parameters were used to predict the motor outcome.Results:Signiifcant differences were found regarding rFA, rADC and infarction volume of ischemic white matter ifber tract among the onset, one, two and three months of the stroke patients (F=13.84,P=0.00;F=64.57,P=0.00 andF=37.41,P=0.00). There was signiifcantly negative correlation between rFA and NIHSS scores at the onset and one month (r=-0.59,t=-4.59,P=0.00;r=-0.34,t=-2.27,P=0.02) and between rADC and NIHSS scores at the onset (r=-0.44,t=-3.04,P=0.00). There was signiifcantly positive correlation between rADC and NIHSS (r=0.28,t=1.83,P=0.04;r=0.39,t=2.69,P=0.00;r=0.63,t=4.99,P=0.00) and between the infarction volume and NIHSS scores (r=0.40,t=2.73,P=0.01;r=0.44,t=3.05,P=0.00;r= 0.32,t=2.13,P=0.04) at one, two and three months from the onset. There was signiifcant correlation between the rFA of the onset, the rADC of three months treatment and MI of thirty-two stroke patients after one year (t=2.95,P=0.00 andt=2.75,P=0.01). For rADC at three months, the area under curves of ROC was 0.905.Conclusion:Our results suggest that there could be a signiifcant correlation between the change of diffusivity of the ischemic white matter and the neuro-functional recovery in the acute stroke patients by analyzing DTI metrics. ADC values at three months after onset of the acute stroke patients may be used to predict the motor outcome.
