| Objective:To explore the application value of magnetic resonance diffusion tensor imaging(DTI)and diffusion tensor tractography(DTT)in the early diagnosis of acute cerebral infarction,clinical staging,disease evaluation at admission and motor function prognosis judgment,in order to provide reference for clinical diagnosis and treatment of acute cerebral infarction.Methods:(1)A total of 73 patients who were hospitalized in the Department of Neurology in Wuzhou Hospital Affiliated to Youjiang Medical University for Nationalities from April 2019 to September 2020 and were clinically diagnosed with acute cerebral infarction were enrolled,and all patients were divided into the hyperacute(8 cases),acute(37cases),and subacute(28 cases)phases according to the disease course;at the same time,according to the results of Lovett’s unarmed muscle strength test,all patients were divided into three groups:good motor function prognosis group(22 cases),general motor function prognosis group(36 cases)and poor motor function prognosis group(15 cases).(2)Conventional MRI,DWI,and DTI scans were performed on all patients to measure FA,VRA,DCavg and Exat values in the infarct area,lesion margin and corresponding contralateral regions,and calculate r FA,r VRA,r DCavg and r Exat in the infarcted lesion area.Paired Samples T-test was used to compare FA,VRA,DCavg and Exat values between the infarcted lesion area,the lesion border area and the corresponding contralateral area,and One-way ANOVA was used to compare the differences in r FA,r VRA,r DCavg and r Exat values between the infarcted lesion areas during different phases,and bivariate correlation was applied to analyze the differences in r FA,r VRA,r DCavg and r Exat values between the infarcted lesion area and the course of cerebral infarction,NIHSS score on admission,and motor function prognosis.(3)The bilateral CST was reconstructed by DTT technique,all cases were classified into three levels of impairment according to the morphology and integrity of the CST on the affected side,and the correlation between the CST impairment level and the NIHSS score on admission and motor function prognosis of the patients was analyzed by Spearman correlation.Results:(1)The DCavg value of the infarcted lesion area at the hyperacute phase were decreased compared with the corresponding contralateral area,while the Exat value was increased compared with the corresponding contralateral area with statistical significance(p<0.05),whereas the FA value and VRA value of the infarcted lesion area were not significantly different from the corresponding contralateral area(p>0.05).At the same time,FA value,VRA value and Exat value in the border zone of the infarcted lesion at the hyperacute phase were increased compared with the corresponding contralateral area,while DCavg value was decreased compared with the corresponding contralateral area,all showing statistically significant differences(p<0.05).(2)The FA value,VRA value and DCavg value of the infarcted lesion area in the acute phase were all decreased compared with the corresponding contralateral area,while the Exat value was increased compared with the corresponding contralateral area(p<0.05),while the FA value,VRA value,DCavg value and Exat value of the infarcted lesion margin area in the acute phase were not significantly different from the corresponding contralateral area(p>0.05).(3)The FA value,VRA value and DCavg value of the infarcted lesion area at the subacute phase were all decreased compared with the corresponding contralateral area,while the Exat value was increased compared with the corresponding contralateral area at the acute phase(p<0.05).At the same time,there was no significant difference in FA value,VRA value,DCavg value or Exat value between the border zone of infarct lesion at subacute phase and the corresponding contralateral area(p>0.05).(4)There were significant differences(p<0.05)in the values of r FA,r VRA,r DCavg and r Exat in the infarcted lesion area between different cerebral infarction phases,and Spearman correlation analysis was used to show that the values of r FA,r VRA and r Exat in the infarcted lesion area were significantly negatively correlated with the course of cerebral infarction(r_s=-0.675,-0.677,-0.657,p<0.05),that is,the values of r FA,r VRA and r Exat in the lesion area tended to decrease overall with increasing time from onset,whereas the value of r DCavg in the infarcted lesion area were significantly and positively correlated with the course of cerebral infarction(r_s=0.743,p<0.05),that is,the values of r DCavg in the lesion area tended to increase overall with increasing time from onset.(5)There was no correlation between the values of r FA,r VRA,r DCavg and r Exat in the focal area of acute cerebral infarction and the NIHSS score at admission(r_s=0.049,0.085,-0.183,0.212,p>0.05).(6)There was no correlation between the values of r FA,r VRA,r DCavg and r Exat in the focal area of acute cerebral infarction and patients’motor function prognosis(r_s=-0.112,-0.115,0.102,-0.150,p>0.05).(7)The CST impairment grade of the affected side was positively correlated with the NIHSS score at admission(r_s=0.597,p<0.05),that is,the higher the CST impairment grade,the greater the NIHSS score at admission.(8)The CST impairment grade of the affected side was significantly negatively correlated with the motor function prognosis of the patient(r_s=-0.630,p<0.05),that is,the higher the level of CST damage,the worse the motor function prognosis of the patient.Conclusions:(1)There is a specific evolution of the values of each parameter of DTI in the lesion area of acute cerebral infarction at different cerebral infarction phases,and the combined application of each parameter value(r FA,r VRA,r DCavg,r Exat)will help to judge the onset time of patients,and then provide a basis for the early diagnosis,clinical staging,and personalized treatment of acute cerebral infarction.(2)DTI technique may have some application value in judging ischemic penumbra.(3)The values of each parameter of DTI((r FA,r VRA,r DCavg,r Exat)in the lesion area of acute cerebral infarction could not be used to evaluate the condition of patients on admission and to predict the motor function prognosis of patients.(4)The degree of CST damage can provide an important reference for the evaluation of the condition on admission and the prediction of motor function prognosis in patients with acute cerebral infarction. |
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