Assessment of arcuate fasciculus with diffusion-tensor tractography may predict the prognosis of aphasia in patients with left middle cerebral artery infarcts
Assessment of arcuate fasciculus with diffusion-tensor tractography may predict the prognosis of aphasia in patients with left middle cerebral artery infarcts
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DOI：
10.1007/s00234-009-0534-7
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发表时间：
2009-09-01
期刊：
影响因子：
2.8
通讯作者：
Nakagawa, Masanori
中科院分区：
文献类型：
--
作者：
Hosomi, Akiko;Nagakane, Yoshinari;Nakagawa, Masanori
在脑梗塞的早期阶段，临床上常常很难评估失语症的严重程度。为此，需要一种能够客观评估言语功能的方法。我们研究了弥散张量成像(DT)在评估失语症方面的临床价值。13名在卒中后2天内接受扫描的左撇子大脑中动脉梗死患者参加了这项研究。对10名对照受试者的磁共振数据也进行了DT纤维束成像检查。根据出院时失语症的严重程度，患者被分为两组：失语组6例，非失语组7例。评价各向异性分数(FA)和弓状束纤维数量。计算FA和纤维数量的不对称指数。弓状束纤维的FA值在患者组和对照组的大脑半球之间没有差异。在对照组和非失语症组中，弓状束纤维的数量明显向左不对称，而在失语症组中则没有。失语组神经纤维数量不对称指数向右明显低于非失语组(P=0.015)和对照组(P=0.005)。房颤纤维数目左侧不对称丢失预测出院时失语的敏感度为0.83，特异度为0.86。DT纤维束造影术显示弓状束纤维不对称性在急性脑梗塞时可作为预测血管性失语预后的参考指标。
It is often clinically difficult to assess the severity of aphasia in the earliest stage of cerebral infarction. A method enabling objective assessment of verbal function is needed for this purpose. We examined whether diffusion tensor (DT) tractography is of clinical value in assessing aphasia.Thirteen right-handed patients with left middle cerebral artery infarcts who were scanned within 2 days after stroke onset were enrolled in this study. Magnetic resonance data of ten control subjects were also examined by DT tractography. Based on the severity of aphasia at discharge, patients were divided into two groups: six patients in the aphasic group and seven in the nonaphasic group. Fractional anisotropy (FA) and number of arcuate fasciculus fibers were evaluated. Asymmetry index was calculated for both FA and number of fibers.FA values for the arcuate fasciculus fibers did not differ between hemispheres in either the patient groups or the controls. Number of arcuate fasciculus fibers exhibited a significant leftward asymmetry in the controls and the nonaphasic group but not in the aphasic group. Asymmetry index of number of fibers was significantly lower (rightward) in the aphasic group than in the nonaphasic (P = 0.015) and control (P = 0.005) groups. Loss of leftward asymmetry in number of AF fibers predicted aphasia at discharge with a sensitivity of 0.83 and specificity of 0.86.Asymmetry of arcuate fasciculus fibers by DT tractography may deserve to be assessed in acute infarction for predicting the fate of vascular aphasia.