本文選題：卒中　切入點(diǎn)：擴(kuò)散張量成像　出處：《東南大學(xué)》2015年碩士論文

【摘要】：第一部分慢性缺血性腦卒中患者-下行運(yùn)動(dòng)纖維束的DTI診斷價(jià)值分析目的采用擴(kuò)散張量成像技術(shù)(diffusion tensor imaging, DTI),探討慢性缺血性腦卒中患者,下行運(yùn)動(dòng)纖維束的完整性與運(yùn)動(dòng)預(yù)后的關(guān)系。方法收集2012年4月至2013年12月東南大學(xué)附屬中大醫(yī)院慢性缺血性腦卒中患者47例；匹配健康志愿者20名。采集DTI數(shù)據(jù),重建雙側(cè)下行運(yùn)動(dòng)纖維束,包括皮質(zhì)脊髓束(corticospinal tract, CST)及輔助運(yùn)動(dòng)纖維束(alternate motor fibers, aMF),并評(píng)估卒中組患側(cè)與健側(cè)內(nèi)囊后肢各向異性分?jǐn)?shù)(fractional anisotropy, FA)、CST及全部下行運(yùn)動(dòng)纖維束(CST+aMF)數(shù)量,觀察該值及其偏側(cè)性指數(shù)(lateal index, LI)與Fugl-Meyer上肢運(yùn)動(dòng)量表(FMA)的相關(guān)性。并根據(jù)下行纖維束損傷形態(tài)將卒中組分為CST+aMF(組1),無(wú)CST及aMF(組2),CST(組3)和MF(組4)四個(gè)亞組,觀察各組FMA變化。結(jié)果相較于對(duì)照組,卒中組患側(cè)內(nèi)囊后肢FA值、CST及(CST+aMF)的數(shù)量均明顯降低(均P0.01,FA：0.45±0.08,CST：26.32±29.98,CST+aMF:36.72±37.34)。組1、2、3間FMA比較有明顯統(tǒng)計(jì)學(xué)差異(55±12.2,15.8±9.6,34.3±14.7,F=24.2,P0.01)。FALI、CSTLI、(CST+aMF)LI與FMA有顯著線性負(fù)相關(guān)(均P0.01,r=-0.730.r=-0.653：r=-0.692),且(CST+aMF)LI與FMA相關(guān)性較CSTLI更顯著。結(jié)論相較于CST, CST+aMF能更好地評(píng)估卒中患者運(yùn)動(dòng)預(yù)后情況。在卒中患者運(yùn)動(dòng)功能康復(fù)過(guò)程中,要重視aMF的補(bǔ)償作用,從而指導(dǎo)臨床進(jìn)行個(gè)性化的康復(fù)治療。第二部分全自動(dòng)定量觀察缺血性腦卒中后患者皮質(zhì)脊髓束的損害目的采用基于白質(zhì)纖維束骨架的空間統(tǒng)計(jì)分析(tract-based spatial statistics,TBSS)方法全自動(dòng)方式定量觀察缺血性腦卒中后患者皮質(zhì)脊髓束的損害,評(píng)估其在臨床中的應(yīng)用。方法聯(lián)合使用TBSS及正常人的皮質(zhì)脊髓束(corticospinal tract,CST)的模版,全自動(dòng)地獲得缺血性腦卒中后患者個(gè)體的皮質(zhì)脊髓束,量化其平均FA值。入組兩組慢性缺血性腦卒中患者共22例,年齡、性別、利手、腦卒中后時(shí)間、教育程度均匹配。組1共10例,FMA評(píng)分50;組2共12例,FMA評(píng)分為100。分別對(duì)比兩組患者CST的患側(cè)FA值(FAipsi),健側(cè)FA值(FA contra)、患側(cè)/健側(cè)FA指數(shù)(FA ratio)的差異;并對(duì)比同一組患者患側(cè)和健側(cè)FA值的差異。結(jié)果與組2對(duì)比,組1的FAipsi、FAratio明顯下降(P均0.01),FAcontra未出現(xiàn)差異。組IFAipsi明顯低于FAcontra(P0.01);組2兩側(cè)之間未出現(xiàn)差異。結(jié)論運(yùn)動(dòng)功能恢復(fù)差的組1患者的患側(cè)FA值及FAratio明顯降低,說(shuō)明了其患側(cè)CST出現(xiàn)了明顯的損害。聯(lián)合TBSS及正常人模版的方式可自動(dòng)化勾畫(huà)、量化個(gè)體的CST的損害。這種自動(dòng)化方式解決了既往手工定義ROI方式耗時(shí)、客觀性不強(qiáng)的缺點(diǎn),有利于臨床的普及應(yīng)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 鹵0.08CST: 26.32 鹵29.98 aMF:36.72 鹵37.34). There was a significant difference in FMA between the 3 groups (55 鹵12.215.8 鹵9.634.3 鹵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.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R445.2;R743.3

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