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目的利用磁共振扩散张量成像(DTI)及扩散张量纤维束成像(DTT)评价脑缺血性卒中所致皮质脊髓束(CST)损伤程度及与运动功能的关系。资料与方法对15例急性期大脑中动脉供血区缺血性脑卒中患者行常规MRI、DTI和DTT检查,对数据进行离线后处理,采用dTV.II软件处理,获得各向异性分数(FA)图及方向编码彩色图,并重组双侧CST3D纤维束图。对梗死区及健侧相应区域白质进行FA测量。采用Brunnstorm标准判断脑卒中患者患手肌力。结果脑卒中患者梗死区FA值显著低于健侧,两侧相比差异有统计学意义(t=-6.3333,P<0.0000)。病变侧CST表现为受压、变形、移位和中断,CST损伤程度与患手肌力级别经检验呈显著负相关关系(rs=-0.97361,P<0.0001),CST的损伤情况与运动功能的恢复有良好的相关。结论CST损伤严重程度与运动功能的恢复相关,DTI和DTT对观察CST的损害程度、预测恢复程度、指导临床康复治疗具有重要的价值。
Objective To evaluate the relationship between the degree of corticospinal tract injury (CST) induced by cerebral ischemic stroke and motor function using diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT). Materials and Methods Fifteen patients with ischemic stroke in the middle cerebral artery supplying acute phase were examined by conventional MRI, DTI and DTT. The data were processed offline by dTV.II software to obtain the anisotropic fraction (FA) Figure and direction coding color map, and reconstruction of bilateral CST3D fiber bundle map. The infarct area and healthy corresponding white matter area FA measurement. The Brunnstorm criteria was used to determine the hand muscle strength of stroke patients. Results The FA value of infarction area in stroke patients was significantly lower than that in healthy side, and there was significant difference between the two sides (t = -6.3333, P <0.0000). The CST of the lesion showed compression, deformation, displacement and interruption. The degree of CST injury was negatively correlated with the muscle strength of the affected hand (rs = -0.97361, P <0.0001). The damage of CST and motor function Recovery has a good correlation. Conclusion The severity of CST is related to the recovery of motor function. DTI and DTT have important value in observing the extent of CST damage, predicting the degree of recovery and guiding clinical rehabilitation.