Wallerian Degeneration in the Corticospinal Tract Evaluated by Diffusion Tensor Imaging Correlates with Motor Deficit 30 Days after Middle Cerebral Artery Ischemic Stroke
Wallerian Degeneration in the Corticospinal Tract Evaluated by Diffusion Tensor Imaging Correlates with Motor Deficit 30 Days after Middle Cerebral Artery Ischemic Stroke
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DOI：
10.3174/ajnr.a2038
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发表时间：
2010-08-01
影响因子：
3.5
通讯作者：
Serena, J.
中科院分区：
文献类型：
--
作者：
Puig, J.;Pedraza, S.;Serena, J.
背景与目的：幕上脑卒中后cst中WD的量化和临床意义尚不清楚。我们通过DTI和CST常规MR成像的信号强度变化来评估各向异性，以确定这些发现是否与MCA缺血性卒中患者的肢体运动障碍相关。材料和方法：我们研究了60例中风发作12小时内的患者。入院时，进化第3天和第30天，患者接受多模态磁共振成像，包括DTI序列。我们采用m-NIHSS的运动亚指标评分（5a、5b、6a、6b）评估肢体无力的严重程度，并将其分为3组：I组（m-NIHSS评分0）、II组（m-NIHSS评分1-4）和III组（m-NIHSS评分5-8）。测定受影响和未受影响的脑桥cst的FA值和rfa值。结果：仅在第30天，患侧CST的FA值显著低于未患侧（P < 0.001），而rFA与第30天的运动缺陷显著相关（P < 0.001; r = -0.793）。rFA < 0.925对运动障碍的敏感性、特异性和阳性预测值分别为95.2%、94.9%、90.9%和97.4%。结论：DTI显示的CST WD与MCA缺血性卒中后30天的运动缺陷相关。这项研究强调了成像随访30天的效用，以及DTI作为临床试验替代标志物的潜力。
BACKGROUND AND PURPOSE: The quantification and clinical significance of WD in CSTs following supratentorial stroke are not well understood. We evaluated the anisotropy by using DTI and signal-intensity changes on conventional MR imaging in the CST to determine whether these findings are correlated with limb motor deficit in patients with MCA ischemic stroke.MATERIALS AND METHODS: We studied 60 patients within 12 hours of stroke onset. At admission, day 3, and day 30 of evolution, patients underwent multimodal MR imaging, including DTI sequences. We assessed the severity of limb weakness by using the motor subindex scores (5a, 5b, 6a, 6b) of the m-NIHSS and established 3 groups: I (m-NIHSS scores of 0), II (m-NIHSS, 1-4), and III (m-NIHSS, 5-8). FA values and rFAs were measured on the affected and the unaffected CSTs in the pons.RESULTS: FA values for the CST were significantly lower on the affected side compared with the unaffected side only at day 30 (P < .001), and the rFA was significantly correlated with the motor deficit at day 30 (P < .001; r = -0.793). The sensitivity, specificity, and positive and negative predictive values for motor deficit by rFA < 0.925 were 95.2%, 94.9%, 90.9%, and 97.4%, respectively.CONCLUSIONS: WD in the CST revealed by DTI correlates with motor deficit 30 days after MCA ischemic stroke. This study highlights the utility of imaging follow-up at 30 days and the potential of DTI as a surrogate marker in clinical trials.