脑卒中皮质脊髓束及皮质脑桥束损伤的磁共振扩散张量成像研究

Magnetic Resonance Diffusion Tensor Imaging of the Corticospinal Tract and Corticopontine Tract Injury in Stroke

摘要: 目的：探讨磁共振扩散张量成像检测脑卒中皮质脊髓束及皮质脑桥束的损伤及对康复及针灸治疗疗效的预测价值。方法：前瞻性纳入2025年6月至2025年12月脑卒中发病1个月内肢体运动功能障碍患者36例，所有患者行头颅磁共振扩散张量成像(DTI)检查，测量患侧和健侧皮质脊髓束(CST)、皮质脑桥束(CPT)的DTI定量参数：各向异性指数(FA)和纤维数量(FN)，计算患侧CST及CPT的相对FA值(rFA)、相对FN值(rFN)，使用配对样本T检验及非参数秩和检验对患、健侧CST及CPT的FA和FN值进行差异性分析；运用Pearson相关分析法分析DTI参数与康复及针灸治疗1个月后的日常生活活动能力(Activity of Daily Living，ADL)评分之间的相关性，有统计学差异的参数的诊断效能均通过受试者工作特性曲线进行分析。结果：患侧CST的FA值及CPT的FA和FN值均显著低于健侧(P < 0.05)；CST的FA、rFA及CPT的FA、rFA与ADL评分均具有相关性(P < 0.05)，CST的rFA的AUC值最高，为0.849；CST及CPT的FN、rFN与ADL均无相关性(P > 0.05)。结论：磁共振扩散张量成像可以检测脑卒中皮质脊髓束及皮质脑桥束的损伤，对康复及针灸治疗一个月后肢体功能恢复具有预测价值。

Abstract: Objective: To investigate the MR diffusion tensor imaging in detecting the injury of the corticospinal tract and corticopontine tract in stroke and predicting the efficacy of rehabilitation and acupuncture. Methods: A prospective study was conducted on 36 patients with limb motor dysfunction within one month after stroke onset from June 2025 to December 2025. All patients underwent MR diffusion tensor imaging (DTI) to measure quantitative parameters of the ipsilesional and controlesional corticospinal tract (CST) and corticopontine tract (CPT): anisotropy index (FA) and fiber number (FN). The relative FA values (rFA) and relative FN values (rFN) of the ipsilesional CST and CPT were calculated. Paired-sample T-tests and nonparametric rank-sum tests were used to analyze the differences in FA and FN values between the ipsilesional and controlesional sides. Pearson correlation analysis was employed to assess the correlation between DTI parameters and the Activity of Daily Living (ADL) scores after one month of rehabilitation and acupuncture treatment. The diagnostic efficacy of parameters with statistically significant differences was analyzed using the receiver operating characteristic (ROC) curve. Results: The FA values of the ipsilesional CST and CPT, as well as the FN values of ipsilesiona CPT, were significantly lower than those of the controlesional sides (P < 0.05). The FA, rFA of the ipsilesional CST and CPT were all correlated with ADL scores (P < 0.05), with the highest AUC value of rFA for the ipsilesional CST (0.849). No correlation was found between the FN and rFN values of the ipsilesional CST and CPT and ADL scores (P > 0.05). Conclusion: Diffusion tensor imaging can reveal the damage of the corticospinal tract and the corticopontine tract in stroke patients, and it can predict the rehabilitation of limb function after one month of rehabilitation and acupuncture.