缺血性脑卒中辅助运动区功能磁共振的研究

发布时间：2018-04-27 13:36

本文选题：缺血性脑卒中 + 功能磁共振　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：本研究采用皮层厚度、局部一致性(regional homogeneity，Reho)、分数低频振幅（fractional amplitude of frequency fluctuation，fALFF）以及静息态功能连接（resting-states Functional Connectivity，rs-FC）的功能磁共振（functional magnetic resonance imaging，fMRI）的多模态分析方法，观察早期缺血性脑卒中患者，运动相关脑区结构和功能的变化情况，探讨缺血性脑卒中后，患者运动功能损伤恢复的过程及机制。方法：选择单侧皮层下缺血性脑卒中患者20例（男12人，女8人），另外选取23例年龄、性别匹配的健康志愿者（男10人，女13人）作为正常对照组。采用Siemens Tim Trio3.0T磁共振成像系统（Siemens MedicalSystems,Erlangen,Germany）对所有被试者进行常规T1WI（T1weightedimaging，T1加权成像）、T2W（IT2weighted imaging，T2加权成像）、FLAIR、3D解剖像及静息态fMRI(resting states functional-magnetic resonanceimaging,rs-fMRI)扫描。运用FreeSurfer V.5.1.0软件进行大脑皮层厚度计算。采用基于Matlab2011b运行下的DPARSFA、REST软件进行静息态的fMRI数据处理和分析。首先测量患侧SMA区的ReHo值和fALFF值；其次定义8个运动相关脑区，双侧辅助运动区(supplement motor area，SMA)、双侧初级运动皮层（primary motor cortex，M1）双侧前运动区(premotor cortex，PM)、双侧扣带运动区（cingulated motor areas，CMA）作为感兴趣区（regional of intrest, ROI），进行它们之间功能连接的分析；再次定义患侧SMA区作为ROI，将它与全脑进行功能连接的分析。最后采用一般线性模型对患侧SMA区皮层厚度、ReHo值和fALFF值进行统计学分析（将年龄和性别作为协变量）。运用REST软件中的双样本t检验进行患者与正常对照的组间功能连接模式差异的比较，并观察有统计学意义的激活区的大小、所在位置、峰值以及坐标等。结果：结果显示患侧半球SMA区较正常对照存在变薄区域(单体素阈值取p0.05,同时运用FDR校正进行cluster水平的校正，p 0.05)。测量患侧SMA区ReHo值分析结果显示,患者组患侧SMA区的ReHo值较正常对照组增高(p 0.05)。患者组患侧SMA区的fALFF值较正常对照组降低（p 0.05）。患侧SMA区的功能连接分析结果显示,患者组较正常对照连接增强的区域主要包括：患侧M1区、健侧SMA区等。功能连接减弱的区域主要包括：双侧小脑半球、健侧PM区等（单体素阈值取p 0.05，同时运用FDR校正进行cluster水平的校正，p 0.05)。结论: 1、缺血性脑卒中患者离病灶较远的患侧SMA区皮层出现变薄区域,提示离病灶较远的区域出现了结构的损伤，并且这种结构的损伤从病变的较早时期就已经开始。 2、缺血性脑卒中患者患侧SMA区fALFF值降低，提示该区域神经元自发性活动的降低；患侧SMA区ReHo值升高，，提示该区域脑功能活动的同步性增强。提示了，皮层下运动中枢损伤后，皮层的运动相关脑区信息传递与处理的效率提高，形成代偿机制，以代偿结构损伤区域的功能，维持相应的功能活动。 3、缺血性脑卒中患者患侧SMA区通过与双侧Ml区、PM区、CMA区和对侧SMA区之间功能连接模式的改变，维持相应的功能，这是损伤后的又一个有效的代偿和皮层功能重组的机制。
[Abstract]:Purpose :

In this study , the changes of functional magnetic resonance imaging ( FALFF ) and resting - states functional Connectivity ( rs - FC ) in early ischemic stroke were investigated by the multi - modal analysis method of cortical thickness , regional coherence ( Reho ) , fractional amplitude of frequency fluctuation ( fALFF ) and resting - states functional Connectivity ( rs - FC ) .

Method :

Twenty patients ( 12 men and 8 women ) with ischemic stroke in one - sided cortex were selected and 23 healthy volunteers ( 10 men and 13 women ) matched with age and sex were selected as the normal control group . Using the Siemens Tim Trio3 . 0T magnetic resonance imaging system ( Siemens MedicalSystems , Erlangen , Germany ) , all subjects were subjected to conventional 1WI ( T1weighted imaging ) , T2W ( IT2weighted imaging , T2 - weighted imaging ) , FLAIR , 3D anatomical image and resting states functional - magnetic resonance anceimaging , rs - fmri scans .
Secondly , eight motion - related brain regions , two - sided auxiliary motor area ( SMA ) , primary motor cortex ( M1 ) , two - sided anterior motor cortex ( PM ) , double - sided anterior motor cortex ( PM ) , and cingulated motor areas ( CMA ) were defined as regions of interest ( ROI ) , and their functional connections were analyzed ;
In the end , the thickness , ReHo value and fALFF value of the affected SMA area were analyzed by using the general linear model ( age and sex as covariant ) . The difference of the functional connection patterns between the patients and the normal control group was compared by using the dual - sample t test in REST software , and the size , the location , the peak value and the coordinates of the active area with statistical significance were observed .

Results :

The results showed that the SMA area of the affected hemisphere was thinner than that of the normal control ( p < 0.05 ) . The results of ReHo value analysis of the SMA area in the affected area showed that the ReHo value of the SMA area in the patient group was higher than that of the normal control group ( p 0.05 ) . The fALFF value of the SMA area in the patient group was lower than that of the normal control group ( p 0.05 ) . The results of functional connection analysis showed that the area of the patients with higher functional connection was mainly composed of bilateral cerebellar hemisphere , healthy side PM region and so on ( single voxel threshold was p 0.05 , and the correction of cluster level was performed by using the correction of fdr correction , p 0.05 ) .

Conclusion :

1 . In patients with ischemic stroke , the area of SMA area on the affected side of the lesion was thinner , which suggested that the structure was damaged in the region farther away from the lesion , and the damage of this structure had started from the earlier period of the lesion .

2 . The value of fALFF decreased in the patients with ischemic stroke , suggesting that the spontaneous activity of neurons in the area decreased ;
The ReHo value in the affected area of the affected area is increased , which suggests that the regional cerebral function activity is enhanced . It is suggested that the transfer and processing efficiency of the movement - related brain area of the cortex after the injury of the motor cortex in the cortex is improved , the compensatory mechanism is formed , and the function of the damaged area of the compensatory structure is compensated , and the corresponding functional activity is maintained .

3 . The function of SMA in ischemic stroke patients was maintained by the change of functional linkage model between bilateral Ml area , PM area , CMA area and contralateral SMA area , which is another effective mechanism for compensatory and cortical function recombination after injury .

【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R743.3

【参考文献】