Axial diffusivity changes in the motor pathway above stroke foci and functional recovery after subcortical infarction
Axial diffusivity changes in the motor pathway above stroke foci and functional recovery after subcortical infarction
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中风病灶上方运动通路的轴向扩散性变化和皮质下梗死后的功能恢复
DOI：
10.3233/rnn-170747
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发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Zeng, Jinsheng
中科院分区：
文献类型：
--
作者：
Liu, Gang;Peng, Kangqiang;Zeng, Jinsheng
背景资料：脑梗死灶下方运动通路纤维束的继发性变性和脑卒中后功能恢复已得到很好的证实，但脑梗死灶上方运动通路纤维束的作用尚不清楚。目的：本研究旨在研究皮质下脑梗死后12周内病变上方运动纤维的弥散变化，并确定运动改善的预测因素。在皮质下梗死后1、4和12周（W）进行扩散张量成像和Fugl-Meyer（FM）量表。使用比例恢复模型残差将患者分配至比例恢复组和恢复较差组。感兴趣区域分析用于评估卒中病变上方和下方运动通路的弥散变化。结果：与对照组相比，恢复良好组和恢复不良组的同侧初级运动区（PMA）和大脑脚（CP）下白色物质的轴向扩散率（AD）在W1时均较低，而对侧PMA和CP的AD值均较低（P均< 0.05）。卒中后4 ~ 12周，同侧CP的AD相对稳定，而同侧PMA的AD显著增加（P < 0.05）。在所有患者中，FM评分的变化在病灶同侧PMA的AD变化较高的患者中更大。只有最初的损害或病变体积是预测运动的改善，在12周内中风后的患者比例或恢复差recovery.Conclusion：增加AD的运动通路以上中风灶可能与运动皮层下梗死后的恢复。早期测量同侧非缺血性运动通路的弥散指标在预测未来运动改善模式（成比例或不良恢复）方面的价值有限。
Background: Secondary degeneration of the fiber tract of the motor pathway below infarct foci and functional recovery after stroke have been well demonstrated, but the role of the fiber tract above stroke foci remains unclear.Objective: This study aimed to investigate diffusion changes in motor fibers above the lesion and identify predictors of motor improvement within 12 weeks after subcortical infarction.Methods: Diffusion tensor imaging and the Fugl-Meyer (FM) scale were conducted 1, 4, and 12 weeks (W) after a subcortical infarct. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Region of interest analysis was used to assess diffusion changes in the motor pathway above and below a stroke lesion. Multivariable linear regression was employed to identify predictors of motor improvement within 12 weeks after stroke.Results: Axial diffusivity (AD) in the underlying white matter of the ipsilesional primary motor area (PMA) and cerebral peduncle (CP) in both proportional and poor recovery groups was lower at W1 compared to the controls and values in the contralesional PMA and CP (all P < 0.05). Subsequently, AD in the ipsilesional CP became relatively stable, while AD in the ipsilesional PMA significantly increased from W4 to W12 after stroke (P < 0.05). In all of the patients, changes in the FM scores were greater in those with higher changes in AD of the ipsilesional PMA. Only initial impairment or lesion volume was predictive of motor improvement within 12 weeks after stroke in patients with proportional or poor recovery.Conclusion: Increases of AD in the motor pathway above stroke foci may be associated with motor recovery after subcortical infarction. Early measurement of diffusion metrics in the ipsilesional non-ischemic motor pathway has limited value in predicting future motor improvement patterns (proportional or poor recovery).