摘要
背景:基底核区出血性和缺血性病变,最容易造成相邻皮质脊髓束损伤,从而导致肢体运动功能程度障碍。功能磁共振扩散张量成像技术能真实有效地显示脑内白质结构,尤其是发生病变时,相邻和相关的白质纤维结构受到不同程度的影响和破坏,以扩散张量成像的各向异性指数最为敏感。目的:应用扩散张量成像技术评估左侧基底核缺血性和出血性病变对皮质脊髓束通路的影响,并比较两种情况下皮质脊髓束通路各向异性指数的差异。设计、时间及地点:对比观察,于2005-10/2008-12在昆明医学院第一附属医院磁共振室完成。对象:左侧基底核出血患者20例,左侧基底核缺血性病变患者27例。方法:利用GE1.5T扫描仪及SUN工作站行全脑数据收集和后处理,在各向异性指数图像上分别测量延髓、脑桥、大脑脚、基底核、放射冠及半卵圆中心等层面的皮质脊髓束通路走行区各向异性指数的测量。兴趣区大小的确定由个体纤维束轴位图上其结构所决定,以不超出该结构的范围、同时有2人对兴趣区大小进行肯定为准。主要观察指标:常规磁共振明确基底核区出血和缺血性病变患者,采集扩散张量成像数据并在工作站的扩散张量成像软件进行皮质脊髓束走行区域各向异性指数测量和分析。结果:左侧基底核区的出血、缺血性病变对左侧皮质脊髓束通路各个水平层面结构的影响程度不同,其各向异性指数的统计学分析,α=0.05。缺血及出血性病变患者延髓水平皮质脊髓束的各向异性指数差异无显著性意义(P=0.05);脑桥水平直至半卵圆中心各层皮质脊髓束的各向异性指数差异有显著性意义(P<0.001);尤其是基底核层面和放射冠层面的P值最小,又以放射冠层面最明显。结论:扩散张量成像结果显示,基底核区缺血性病变对大脑脚层面及其以上的皮质脊髓束的影响较出血性病变大。
BACKGROUND： Hemorrhagic and ischemic diseases at basal ganglia region could induce adjacent corticospinal tract （CST） injury, resulting limb motor dysfunction. Functional MR diffusion tensor imaging （DTI） could effectively display white matter in the brain. In particular when adjacent and related white matter fiber structures are damaged in pathological changes, fractional anisotropy （FA） of diffusion tensor imaging is the most sensitive. OBJECTIVE： To explore the influence of hemorrhagia and ischemia at left basal ganglia region on the CST pathway using DTI, and compare the difference of FA features of CST pathway under two conditions. DESIGN, TIME AND SETTING： Comparative observation. The study was performed at the Department of MRI, First Affiliated Hospital of Kunming Medical University between October 2005 and December 2008. PARTICIPANTS： A total of 20 patients with hemorrhage of left basal ganglia and 27 with infarction of left basal ganglia. METHODS： Data of entire brain were collected and processed using 1.5 T GE MRI and SUN workstation. Every layer FA values were measured on whole CST pathway, including medulla, pons, cerebral peduncle, basal ganglia, corona radiate and semioval center. The size of region of interest （ROI） was identified by the axial view of individual fascicles, which did not exceed that structure scope and two people confirmed the ROI. MAIN OUTCOME MEASURES： Conventional MRI was used to confirm hemorrhage and infarction of left basal ganglia. Data of DTI was collected and used to measure and analyze FA of corticospinal tract pathway using DTI software. RESULTS： DTI depicted the FA values of different level CST were different under both conditions （a=0.05）. No differences were found in FA value at medulla level under both sides （P=0.05）. Pons, cerebral peduncle, basal ganglia and corona radiate levels showed significant differences in CST FA value under both sides （P 〈 0.001 ）. The P values of CST FA of basal ganglia and corona radiate levels were the most smallest, especially the corona radiate level. CONCLUSION： DTI results show that left corticospinal tract was significantly affected by left basal ganglia stroke compared with hemorrhage.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第26期5094-5097,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
