Rong Dongdong, Zhang Miao, Ma Qingfeng, Lu Jie, Li Kuncheng
Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China ; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, China.
Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.
Biomed Res Int. 2014;2014:524096. doi: 10.1155/2014/524096. Epub 2014 May 25.
Diffusion tensor imaging (DTI) and tractography (DTT) provide a powerful vehicle for investigating motor recovery mechanisms. However, little is known about these mechanisms in patients with medullary lesions. We used DTI and DTT to evaluate three patients presenting with motor deficits following unilateral medulla infarct. Patients were scanned three times during 1 month (within 7, 14, and 30 days after stroke onset). Fractional anisotropy (FA) values were measured in the medulla, cerebral peduncle, and internal capsule. The three-dimensional corticospinal tract (CST) was reconstructed using DTT. Patients 1 and 2 showed good motor recovery after 14 days, and the FA values of their affected CST were slightly decreased. DTTs demonstrated that the affected CST passed along periinfarct areas and that tract integrity was preserved in the medulla. Patient 3 had the most obvious decrease in FA values along the affected CST, with motor deficits of the right upper extremity after 30 days. The affected CST passed through the infarct and was disrupted in the medulla. In conclusion, DTI can detect the involvement and changes of the CST in patients with medulla infarct during motor recovery. The degree of degeneration and spared periinfarct CST compensation may be an important motor recovery mechanism.
扩散张量成像（DTI）和纤维束成像（DTT）为研究运动恢复机制提供了有力手段。然而，对于延髓病变患者的这些机制知之甚少。我们使用DTI和DTT评估了3例单侧延髓梗死伴运动功能缺损的患者。在1个月内（卒中发作后7天、14天和30天）对患者进行了3次扫描。在延髓、大脑脚和内囊中测量了分数各向异性（FA）值。使用DTT重建了三维皮质脊髓束（CST）。患者1和患者2在14天后显示出良好的运动恢复，其患侧CST的FA值略有下降。DTT显示患侧CST沿梗死灶周围区域走行，且在延髓中纤维束完整性得以保留。患者3患侧CST的FA值下降最为明显，30天后出现右上肢运动功能缺损。患侧CST穿过梗死灶并在延髓中中断。总之，DTI能够检测延髓梗死患者运动恢复过程中CST的受累情况及变化。退变程度和梗死灶周围CST的保留补偿可能是重要的运动恢复机制。
