Cho Min Jye, Jang Sung Ho
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 705-717 Namku, Taegu, Republic of Korea.
J Integr Neurosci. 2021 Sep 30;20(3):677-685. doi: 10.31083/j.jin2003072.
Relationships among language ability, arcuate fasciculus and lesion volume were investigated by use of diffusion tensor tractography in patients with putaminal hemorrhage. Thirty-three right-handed patients within six weeks of hemorrhage onset were recruited. Correlation of the aphasia quotient with subset (fluency, comprehension, repetition, naming) scores, diffusion tensor tractography parameters and lesion volume of patients, aphasia quotient ( = 0.446) with subset (naming: = 0.489) score had moderate positive correlations with fractional anisotropy of the left arcuate fasciculus. The aphasia quotient subset (repetition) score had a strong positive correlation with fractional anisotropy of the left arcuate fasciculus ( = 0.520), whereas, aphasia quotient subset (fluency and comprehension) scores had no significant correlations with fractional anisotropy of the left arcuate fasciculus after Benjamini-Hochberg correction. Aphasia quotient ( = 0.668) with subset (fluency: = 0.736, comprehension: = 0.739, repetition: = 0.649, naming: = 0.766) scores had strong positive correlations with the tract volume of the left arcuate fasciculus and strong negative correlations with lesion volume ( = -0.521, fluency: = -0.520, comprehension: = -0.513, repetition: = -0.518, naming: = -0.562). Fractional anisotropy of the left arcuate fasciculus had a moderate negative correlation with lesion volume ( = -0.462), whereas the tract volume of the left arcuate fasciculus had a strong negative correlation with lesion volume ( = -0.700). According to the result of mediation analysis, tract volume of the left arcuate fasciculus fully mediated the effect of lesion volume on the aphasia quotient. Regarding the receiver operating characteristic curve, the lesion volume cut-off value was 29.17 cm and the area under the curve (0.74), sensitivity (0.77) and specificity (0.80) were higher than those of fractional anisotropy, tract volume and aphasia quotient cut-off values. It was found that level of language disability was related to lesion volume as well as to injury severity of arcuate fasciculus in the dominant hemisphere of patients with putaminal hemorrhage. In particular, the tract volume of the arcuate fasciculus in the dominant hemisphere fully mediated the effect of lesion volume on language ability. Additionally, a lesion volume of approximately 30 cm was helpful in discriminating arcuate fasciculus discontinuation in the dominant hemisphere.
运用扩散张量纤维束成像技术，对壳核出血患者的语言能力、弓状束和病灶体积之间的关系进行了研究。招募了33例出血发作六周内的右利手患者。失语商与亚组（流畅性、理解、复述、命名）得分、扩散张量纤维束成像参数及患者病灶体积的相关性分析显示，失语商（=0.446）与亚组（命名：=0.489）得分与左侧弓状束的分数各向异性呈中度正相关。失语商亚组（复述）得分与左侧弓状束的分数各向异性呈强正相关（=0.520），而经Benjamini-Hochberg校正后，失语商亚组（流畅性和理解）得分与左侧弓状束的分数各向异性无显著相关性。失语商（=0.668）与亚组（流畅性：=0.736，理解：=0.739，复述：=0.649，命名：=0.766）得分与左侧弓状束的纤维束体积呈强正相关，与病灶体积呈强负相关（=-0.521，流畅性：=-0.520，理解：=-0.513，复述：=-0.518，命名：=-0.562）。左侧弓状束的分数各向异性与病灶体积呈中度负相关（=-0.462），而左侧弓状束的纤维束体积与病灶体积呈强负相关（=-0.70）。中介分析结果显示，左侧弓状束的纤维束体积完全介导了病灶体积对失语商的影响。关于受试者工作特征曲线，病灶体积的截断值为29.17 cm，曲线下面积（0.74）、敏感性（0.77）和特异性（0.80）均高于分数各向异性、纤维束体积和失语商的截断值。研究发现，壳核出血患者的语言残疾程度与病灶体积以及优势半球弓状束的损伤严重程度有关。特别是，优势半球弓状束的纤维束体积完全介导了病灶体积对语言能力的影响。此外，约30 cm的病灶体积有助于鉴别优势半球弓状束的中断情况。
