摘要
目的探讨扩散张量成像(DTI)检查脑梗死恢复期患者桥脑小脑束的扩散参数在发病3个月内和1年后的动态改变,分析其与脑卒中后远期步行能力的关系。方法选取亚急性期(病程3周~3个月)大脑中动脉供血区梗死偏瘫患者30例,分别于发病3个月内(首次)和发病1年后(随访时)采用DTI在感兴趣区桥脑小脑束的小脑中脚区域测定左、右两侧的部分各向异性(FA)值作为影像学参数;同时采用国立卫生研究所卒中量表(NIHSS)对入选患者的神经功能缺损情况进行评估,包括上、下肢运动评定部分,并作为偏瘫分级(PG)的依据(即上肢和下肢运动评分之和);并于随访时,采用Brunel平衡量表(BBA)、改良的Rankin量表(mRS)和功能独立性评定量表(FIM)分别评定入选患者的平衡功能、功能预后和生活自理能力。结果首次扫描后发现,桥脑小脑束未受累侧FA值(0.499±0.053)和随访时桥脑小脑束未受累侧的FA值(0.490±0.094)明显低于同期受累侧。首次检测所得桥脑小脑束的rFA值与首次和随访时的下肢运动PG分值、上肢运动PG分值、运动总PG分值和FIM评分呈显著相关,差异均有统计学意义(P<0.05)。随访时,上肢、下肢和总运动结局是否良好与桥脑小脑束的rFA值显著相关,差异均有统计学意义(P<0.05)。首次桥脑小脑束的rFA值预测下肢运动结局的ROC曲线下面积比值为0.84(P=0.002),最佳界值点为0.92(敏感度71.4%,特异度73.9%)。结论亚急性期大脑中动脉梗死患者桥脑小脑束的DTI参数(rFA值)可预测其长期运动能力的恢复情况,且桥脑小脑束的rFA值是预测下肢运动结局是重要参考指标。
Objective To explore the changes in the diffusion tensor imaging(DTI)parameters of the pontocerebellar tract 3 months and one year after ischemic stroke and analyze the data′s potential for predicting long-term motor outcomes.Methods Thirty patients with middle cerebral artery infarction were prospectively studied using DTI within 3 months and 1 year after the onset.A region of interest-based analysis was performed for the fractional anisotropy(FA)of the middle cerebellar peduncles(MCP)in the pontocerebellar fibers(PCF).Neurological functioning was evaluated using the National Institutes of Health Stroke Scale and the degree of paresis was assessed at the same time using paresis grading.At one year after the onset,balance function,functional prognosis and self-care ability were evaluated using the Brunel Balance Scale,the modified Rankine Scale and the Functional Independence Scale respectively.Results The average FA on the healthy side 3 months and 1 year after onset was significantly less than on the affected side at each time point.The ratio of the FA of the affected side to that of the unaffected side(rFA)in the PCF correlated significantly with the average paresis scores of the lower and upper extremity and the total paresis score at each time point.Moreover,the rFA of the PCF was significantly correlated with the average functional independence score,the prognosis for the upper and lower extremities as well as motor functioning.The area ratio under the ROC curve of the PCF for predicting lower extremity motor outcome was 0.84,and the optimal threshold was 0.92(sensitivity 71.4%,specificity 73.9%).The area ratio under the ROC curve was not a significant predictor of upper extremity motor outcome.Conclusion The DTI parameter rFA of the PCF in patients with subacute middle cerebral artery infarction can help to predict the long-term recovery of motor ability.It can serve as an important reference index for predicting the long-term motor ability of the lower limbs.
作者
赵瀛
施爱群
王大明
王凌燕
宋杰
李捷
Zhao Ying;Shi Aiqun;Wang Daming;Wang Linyan;Song Jie;Li Jie(Department of Rehabilitation Medicine,The Affiliated Traditional Chinese Medicine Hospital of Zhejiang University of Traditional Chinese Medicine,Jinhua 321017,China;Department of Rehabilitation Medicine,The First Affiliated Hospital of Zhejiang University,Hangzhou 310006,China;Department of Rehabilitation Medicine,No.1 People′s Hospital of Huzhou City,Huzhou 313000,China;Department of Imaging,The Affiliated Traditional Chinese Medicine Hospital of Zhejiang University of Traditional Chinese Medicine,Jinhua 321017,China)
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2021年第3期221-226,共6页
Chinese Journal of Physical Medicine and Rehabilitation
关键词
脑梗死
桥脑小脑束
扩散张量成像
步行
长期预后
Ischemic stroke
Pontocerebellar fibers
Diffusion tensor imaging
Walking
Long-term prognoses
