Diffusion tensor pyramidal tractography in patients with anterior choroidal artery infarcts
Diffusion tensor pyramidal tractography in patients with anterior choroidal artery infarcts
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DOI：
10.3174/ajnr.a0855
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发表时间：
2008-03-01
影响因子：
3.5
通讯作者：
Urbach, H.
中科院分区：
文献类型：
--
作者：
Nelles, M.;Gieseke, J.;Urbach, H.
背景和目的：脉络膜前动脉（AchoA）卒中常演变为波动性轻偏瘫，有时进展为高度轻偏瘫或偏瘫，但也可能完全消退。AchoA梗死皮质脊髓束（CST）和CST的完整性的空间关系进行了研究与扩散张量成像（DTI），以确定预后参数相关的扩散各向异性变化AchoA strok.MATERIALS和METHODS：25 AchoA中风患者进行了前瞻性检查与3 T。在发病后平均3天内进行DTI和弥散张量纤维束成像（DTT）。分析包括以下内容：1）弥散加权成像上的卒中大小; 2）最大卒中范围与对侧同源结构的各向异性分数（FA）和表观弥散系数; 3）与CST相关的病变位置（“受累”）; 4）受累与未受累CST的纤维轨迹数量（“纤维比率”）;以及5）同侧纤维断裂的存在。影像学检查结果与症状发作后3个月的临床状态有关，包括有利、中等或不利的运动结局。结果：FA差异（受累半球与非受累半球FA减少的线索）显著高于预后不良的患者（P = 0.03）。预后良好的患者FA几乎对称。除2例患者（完全受累，n = 3;部分受累，n = 20）外，所有患者的缺血性病变均累及CST。2例CST完全中断，2例患者均为偏瘫（无中断，n = 14;部分中断，n = 9）。纤维中断和CST受累与AchoA卒中后运动评分呈负相关（P
BACKGROUND AND PURPOSE: Anterior choroidal artery (AchoA) stroke often evolves into undulating hemipareses, which sometimes progress to high-grade hemiparesis or hemiplegia but may also completely regress. Spatial relationships of AchoA infarcts to corticospinal tracts (CSTs) and CST integrity were investigated with diffusion tensor imaging (DTI) to identify prognostic parameters related to diffusion anisotropy changes in AchoA stroke.MATERIALS AND METHODS: Twenty-five AchoA stroke patients were prospectively examined with 3T. DTI and diffusion tensor tractography (DTT) within a 3-day mean interval after onset. Analysis included the following: 1) stroke size on diffusion-weighted imaging; 2) fractional anisotropy (FA) and apparent diffusion coefficients at the largest stroke extents versus contralateral homologous structures; 3) lesion location related to CST ("involvement"); 4) amount of fiber trajectories of affected versus nonaffected CST ("fiber ratio"); and 5) presence of ipsilateral fiber disruption. Imaging findings were related to clinical status 3 months after symptom onset with respect to favorable, moderate, or unfavorable motor outcome.RESULTS: FA differences (clue to FA reduction in the affected versus nonaffected hemisphere) were significantly higher for patients with unfavorable outcome (P =.03). Patients with favorable outcome had nearly symmetrical FA. CSTs were involved in ischemic lesions in all but 2 patients (complete involvement, n = 3; partial, n = 20). Two CSTs were completely disrupted, and both patients were hemiplegic (no disruption, n = 14; partial disruption, n = 9). Fiber disruption and CST involvement correlated negatively with motor score after AchoA stroke (P