缺血性脑卒中后下行运动纤维束作用的DTI研究

发布时间：2018-03-31 12:42

本文选题：卒中　切入点：扩散张量成像　出处：《东南大学》2015年硕士论文

【摘要】：第一部分慢性缺血性脑卒中患者-下行运动纤维束的DTI诊断价值分析目的采用扩散张量成像技术(diffusion tensor imaging, DTI),探讨慢性缺血性脑卒中患者,下行运动纤维束的完整性与运动预后的关系。方法收集2012年4月至2013年12月东南大学附属中大医院慢性缺血性脑卒中患者47例；匹配健康志愿者20名。采集DTI数据,重建双侧下行运动纤维束,包括皮质脊髓束(corticospinal tract, CST)及辅助运动纤维束(alternate motor fibers, aMF),并评估卒中组患侧与健侧内囊后肢各向异性分数(fractional anisotropy, FA)、CST及全部下行运动纤维束(CST+aMF)数量,观察该值及其偏侧性指数(lateal index, LI)与Fugl-Meyer上肢运动量表(FMA)的相关性。并根据下行纤维束损伤形态将卒中组分为CST+aMF(组1),无CST及aMF(组2),CST(组3)和MF(组4)四个亚组,观察各组FMA变化。结果相较于对照组,卒中组患侧内囊后肢FA值、CST及(CST+aMF)的数量均明显降低(均P0.01,FA：0.45±0.08,CST：26.32±29.98,CST+aMF:36.72±37.34)。组1、2、3间FMA比较有明显统计学差异(55±12.2,15.8±9.6,34.3±14.7,F=24.2,P0.01)。FALI、CSTLI、(CST+aMF)LI与FMA有显著线性负相关(均P0.01,r=-0.730.r=-0.653：r=-0.692),且(CST+aMF)LI与FMA相关性较CSTLI更显著。结论相较于CST, CST+aMF能更好地评估卒中患者运动预后情况。在卒中患者运动功能康复过程中,要重视aMF的补偿作用,从而指导临床进行个性化的康复治疗。第二部分全自动定量观察缺血性脑卒中后患者皮质脊髓束的损害目的采用基于白质纤维束骨架的空间统计分析(tract-based spatial statistics,TBSS)方法全自动方式定量观察缺血性脑卒中后患者皮质脊髓束的损害,评估其在临床中的应用。方法联合使用TBSS及正常人的皮质脊髓束(corticospinal tract,CST)的模版,全自动地获得缺血性脑卒中后患者个体的皮质脊髓束,量化其平均FA值。入组两组慢性缺血性脑卒中患者共22例,年龄、性别、利手、脑卒中后时间、教育程度均匹配。组1共10例,FMA评分50;组2共12例,FMA评分为100。分别对比两组患者CST的患侧FA值(FAipsi),健侧FA值(FA contra)、患侧/健侧FA指数(FA ratio)的差异;并对比同一组患者患侧和健侧FA值的差异。结果与组2对比,组1的FAipsi、FAratio明显下降(P均0.01),FAcontra未出现差异。组IFAipsi明显低于FAcontra(P0.01);组2两侧之间未出现差异。结论运动功能恢复差的组1患者的患侧FA值及FAratio明显降低,说明了其患侧CST出现了明显的损害。联合TBSS及正常人模版的方式可自动化勾画、量化个体的CST的损害。这种自动化方式解决了既往手工定义ROI方式耗时、客观性不强的缺点,有利于临床的普及应用。
[Abstract]:Part I: diagnostic value of DTI in patients with chronic ischemic stroke-descending motor fiber bundle objective to investigate the patients with chronic ischemic stroke by using diffusion Zhang Liang imaging technique and diffusion tensor imaging. Methods from April 2012 to December 2013, 47 patients with chronic ischemic stroke in the Hospital affiliated to Southeast University were collected and 20 healthy volunteers were matched. DTI data were collected. To reconstruct bilateral descending motor fibers, including corticospinal tract (CSTs) and auxiliary motor fibers alternate motor fibersaMFN, and to evaluate the number of fractile anisotropic fractions in the affected and healthy sides of the intracapsular hindlimb in stroke group. To observe the correlation between this value and the hemiplegia index (Li) and the Fugl-Meyer upper limb motion scale (Fugl-Meyer). The stroke group was divided into four subgroups: CST aMF (group 1), no CST (group 2), CST (group 3) and MF (group 4) according to the pattern of descending fiber bundle injury. The changes of FMA in each group were observed. The results were compared with those in the control group. In stroke group, the number of FA value of the posterior limb of the internal capsule was significantly decreased (P0.01FA0.45 卤0.08CST: 26.32 卤29.98 aMF:36.72 卤37.34). There was a significant difference in FMA between the 3 groups (55 卤12.215.8 卤9.634.3 卤14.7FCSTLI aMF)LI and FMA) (P0.01r-0.730.730.r-0.653r-0.653r-0.653r-0.692and the correlation between aMF)LI and FMA was more significant than that of CSTLI. Conclusion compared with CSTs, CST aMF can better evaluate the prognosis of stroke patients. Attention should be paid to the compensatory role of aMF. The second part of automatic quantitative observation of corticospinal tract damage after ischemic stroke objective to use the spatial statistical analysis of tract-based spatial statistics based on the skeleton of white matter fiber bundle to analyze the injury of corticospinal tract in patients with ischemic stroke. The damage of corticospinal tract in patients with ischemic stroke was observed quantitatively by automatic method. Methods the cortical spinal tract of patients with ischemic stroke was automatically obtained by using the template of TBSS and corticospinal tractinal CSTs of normal subjects. The mean FA value was quantified. There were 22 patients with chronic ischemic stroke in the two groups, age, sex, hands, time after stroke, The scores of 10 cases of FMA in group 1 and 12 cases in group 2 were 100. The difference of FA value of affected side, FA contrasting, FA index and FA index of affected side and healthy side were compared between the two groups. The difference of FA between the affected side and the healthy side in the same group was compared with that in group 2. There was no significant difference in FFA ratio between group 1 and group 1 (P < 0.01). The IFAipsi of group 1 was significantly lower than that of group A (P 0.01), but there was no difference between group 2 and group 2.Conclusion the FA value and FAratio of patients with poor motor function in group 1 were significantly lower than those in group 1. The results show that the CST of the affected side is obviously damaged. The way of combining TBSS and normal person template can automatically sketch and quantify the damage of individual CST. This automation method solves the disadvantages of time-consuming and impersonal objectivity in the past manual definition of ROI. It is beneficial to the popularization and application of clinical practice.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.2;R743.3

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