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目的应用磁共振弥散张量成像(DTI)技术前瞻性动态观察皮质下局灶性脑梗死后,病灶上、下方远隔部位的神经纤维继发性变化的过程,探讨其与神经功能恢复的意义。方法选择具有单侧大脑中动脉(MCA)供血的皮质下累及内囊的独立病灶脑梗死患者10例,选择年龄性别相匹配的健康志愿者10名作对照研究。患者分别在发病的第(7±2)天(D7)、第(30±3)天(M1)、第(90±3)天(M3)进行DTI检测,并采用美国国立卫生研究院卒中评分(NIHSS)、简式Fugl-Meyer运动功能评分(FM)法和Barthel生活指数(Barthel Index,BI)评定。结果与对照组比较,病灶侧内囊上、下方远隔部位的部分弥散各向异性(FA)值明显减少,而且从D7至M3内囊上方(0.34±0.01和0.28±0.03,P<0.01)、下方(0.42±0.02和0.37±0.06,P<0.01)有逐渐减少趋势,而平均弥散量(MD)却无明显变化。内囊上、下方的FA值均与NIHSS值呈正相关,内囊下方FA值还与Fugl-Meyer运动评分、BI呈负相关。结论局灶性皮质下脑梗死可引起其顺行性和逆行性远隔部位神经纤维的继发性损害,其临床意义尚有待研究。
Objective To prospectively observe the secondary changes of nerve fibers in the distal and distal foci after focal cerebral cortex infarction by magnetic resonance diffusion tensor imaging (DTI), and to explore its significance in the recovery of neurological function . Methods Ten patients with independent focal cerebral infarction with subcortical involvement of the internal capsule and blood supply of unilateral middle cerebral artery (MCA) were enrolled in this study. Ten healthy volunteers were selected as controls. Patients were assessed for DTI on day 7 (D7), day (30 ± 3) (M1), and day 90 (3) (M3) on the onset of disease and were assessed using the National Institutes of Health Stroke Scale (NIHSS), simple Fugl-Meyer motor function score (FM) and Barthel Index (BI). Results Compared with the control group, the partial diffusion anisotropy (FA) of the distal and distal parts of the lesion was significantly decreased (P <0.01), but also from the top of the D7 to M3 (0.34 ± 0.01 and 0.28 ± 0.03, P <0.01) (0.42 ± 0.02 and 0.37 ± 0.06, P <0.01), while the average diffusivity (MD) did not change significantly. The values of FA in the upper and lower parts of the internal capsule were positively correlated with the NIHSS values. The values of FA in the lower part of the capsule were also negatively correlated with the Fugl-Meyer motor score and BI. Conclusion The focal subcortical cerebral infarction can cause secondary damage to the parasite and retroperitoneal nerve fibers. The clinical significance remains to be studied.