背景:皮质脊髓束(CST)是主要的运动途径;我们旨在探索脑卒中康复过程中CST的结构可塑性机制。
方法:共有25例患者在康复前(T1)进行了扩散张量成像,康复后1个月(T2),康复后2个月(T3),出院后1年(T4)。CST是分段的,和分数各向异性(FA),轴向扩散(AD),平均扩散率(MD),和径向扩散率(RD)使用自动纤维定量纤维束成像确定。侧性指数(LI)与运动功能的基线水平进行相关分析。
结果:同侧CST(IL-CST)中所有节段的FA值均低于正常CST。重复测量方差分析显示时间相关影响FA,AD,和IL-CST的MD,这3个参数有相似的动态趋势。在T1,FA,AD,IL-CST中上段(核心病变周围)的MD值最低;在T2和T3,中下段的值低于T1,而中上段的值逐渐增加;在T4,几乎整个IL-CST的值都高于以前。在T2观察到最高的LI,在对照CST中占主导地位。T1时FA和AD的LI与运动功能变化率呈正相关。
结论:IL-CST表现为从病变周围到远端的加重,随后改善。半球CST的平衡可能与运动功能密切相关,FA和AD的LIs可能对轻中度卒中康复具有预测价值。临床试验注册。URL:http://www。chictr.org.cn;唯一标识符:ChiCTR1800019474。
BACKGROUND: Corticospinal tract (CST) is the principal motor pathway; we aim to explore the structural plasticity mechanism in CST during stroke rehabilitation.
METHODS: A total of 25 patients underwent diffusion tensor imaging before rehabilitation (T1), 1-month post-rehabilitation (T2), 2 months post-rehabilitation (T3), and 1-year post-discharge (T4). The CST was segmented, and fractional anisotropy (FA), axial diffusion (AD), mean diffusivity (MD), and radial diffusivity (RD) were determined using automated fiber quantification tractography. Baseline level of laterality index (LI) and motor function for correlation analysis.
RESULTS: The FA values of all segments in the ipsilesional CST (IL-CST) were lower compared with normal CST. Repeated measures analysis of variance showed time-related effects on FA, AD, and MD of the IL-CST, and there were similar dynamic trends in these 3 parameters. At T1, FA, AD, and MD values of the mid-upper segments of IL-CST (around the core lesions) were the lowest; at T2 and T3, values for the mid-lower segments were lower than those at T1, while the values for the mid-upper segments gradually increased; at T4, the values for almost entire IL-CST were higher than before. The highest LI was observed at T2, with a predominance in contralesional CST. The LIs for the FA and AD at T1 were positively correlated with the change rate of motor function.
CONCLUSIONS: IL-CST showed aggravation followed by improvement from around the lesion to the distal end. Balance of interhemispheric CST may be closely related to motor function, and LIs for FA and AD may have predictive value for mild-to-moderate stroke rehabilitation. Clinical Trial Registration. URL: http://www.chictr.org.cn; Unique Identifier: ChiCTR1800019474.