Clinical Study Of FMRI In Acute Subcortical Cerebral Infarction

Part One Clinical study of DWI,DTI and DKI3.0TMRI in patients with acute subcortical cerebral infarctionObjective:To analyze the evolution of 3.0TMRI diffusion weighted imaging(DWI),diffusion tensor imaging(DTI)and diffusion kurtosis imaging(DKI)parameters in different stages of acute subcortical cerebral infarction,as well as the effects of various parameters on the early diagnosis of subcortical cerebral infarction..Methods:A total of 77 patients with acute subcortical cerebral infarction were enrolled in this study,12 patients were hyperacute disease,18 patients with acute phase,47 patients with subacute phase.the ROI method was used to measure the parameters of the ipsilateral,and the patients with contralateral cerebral infarctions were tested using DWI,DTI,and DKI using Siemens 3.0T magnetic resonance imaging(MRI).We used SPSS 19.0 soft to analyze the clinical value of each parameter in the early diagnosis of subcortical cerebral infarction with paired t test(Bilateral test).Results:DWI-related parameters:ADC value decreased after cerebral infarction,and then gradually increased(P<0.05).False normalization was in the subacute phase.DKI-related parameters:FA value began to increase slightly from the super-acute period,then began to decline as time went on(P<0.05).K?,K//,MK value first sharply increased in the acute phase,and then slow down with the process(P<0.05).DTI-related parameter:D?,D//,MD value firstly decreased,and then gradually increased,while the lowest value appears in the Acute phase.The false normalization period of MK values and MD values appeared in the late subacute phase,and MK values appeared later than MD values.The change range of DTI related parameters was lower than that of DKI,And the parameter change was greater in the parallel direction than the vertical direction.Conclusion:DWI,DTI and DKI can effectively evaluate acute subcortical cerebral infarction.DKI is superior to DWI and DTI in the evaluation of acute subcortical cerebral infarction.It can analyze better the microstructure of acute subcortical cerebral infarction.DKI has a better effect on early diagnosis,early treatment and prognosis of cerebral infarction.Part TwoClinical study of DKI in patients with acute subcortical cerebral infarction after hyperbaric oxygen therapyObjective:To analyze the changes of DKI in patients with acute subcortical cerebral infarction after early hyperbaric oxygen therapy,and to explore the clinical significance of early hyperbaric oxygen in patients with acute subcortical cerebral infarction.Methods:This study recruited 64 patients with acute subcortical cerebral infarction were included,32 of whom were patients with thrombolytic therapy and the others who were not eligible for thrombolysis.The patients with thrombolytic therapy were stochasticly separated into thrombolytic group and hyperbaric oxygenated thrombolysis group,and in the meantime the patients who were not suitable for thrombolytic therapy were randomly divided into routine treatment group and hyperbaric oxygen group.Each group were 16 cases.Hyperbaric oxygen group,thrombolysis group and hyperbaric oxygen thrombolysis group were given conventional supportive therapy.Besides that,hyperbaric oxygen group was given hyperbaric oxygen therapy,thrombolysis group was given intravenous thrombolytic therapy,hyperbaric oxygen Thrombolysis group was treated with hyperbaric oxygen therapy on intravenous thrombolytic therapy.All of the above groups were evaluated before and after 2 weeks of treatment according to the National Institutes of Health Stroke Scale(NIHSS),improved Barthel Index(MBI),and MRI examination.We used the Statistical Product and Service Solutions(SPSS)19.0 software with paired t test bilateral test method to analysis the data of above four groups before and after treatment.The P value was less than 0.05,and the difference was statistically significant.Results:Before treatment,there were no significant differences in NIHSS score and MBI score between routine group,hyperbaric oxygen group,thrombolysis group and hyperbaric oxygen thrombolysis group(P>0.05),At 2 weeks after treatment,the NIHSS score and MBI score of the hyperbaric oxygen group,the thrombolytic group and the hyperbaric oxygen thrombolysis group were significantly different from the conventional group(P<0.05).The NIHSS score and MBI score of the thrombolysis group and the hyperbaric oxygen thrombolysis group were significantly different from that of the hyperbaric oxygen group(P<0.05).Compared with the thrombolysis group,the NIHSS score and MBI score of the hyperbaric oxygen thrombolysis group were statistically significant(P<0.05).Before treatment,compared with the conventional group,hyperbaric oxygen group,thrombolysis group and HBO thrombolysis group MK values,K//and K ? values group compared with the normal group were increased(P<0.05).MK values,K//and K ? values of above four groups were not significantly different in pair-wise comparis(P>0.05).After two weeks of treatment,MK values,K//and K ? values of conventional group,hyperbaric oxygen group,thrombolysis group and HBO thrombolysis group were lower than that before treatment(P<0.05),but still was higher than the normal value(P<0.05).MK values,K//and K ? values changes of the conventional group,hyperbaric oxygen group,thrombolysis group and the hyperbaric oxygen thrombolysis group,which were before and after treatment,increased successively.Conclusion:Early hyperbaric oxygen has a certain clinical significance for patients with acute subcortical cerebral infarction,but the value is lower than that of thrombolytic therapy.If hyperbaric oxygen therapy and thrombolytic therapy are combined with clinical value,DKI is related to hyperbaric oxygen therapy,The efficacy and prognosis of thrombolytic therapy can provide relative objective evidence of imaging.Part Three Clinical study of BOLD in patients with acute subcortical cerebral infarction after hyperbaric oxygen therapyObjective:To investigate the changes of blood oxygen level dependent functional Magnetic Resonance Imaging(BOLD-fMRI)in patients with acute subcortical cerebral infarction,and to analyze the abnormal changes of brain function before and after hyperbaric oxygen therapy.Methods:51 patients with acute subcortical cerebral infarction were enrolled in this study.Among them,13 cases were treated with hyperbaric oxygen therapy as hyperbaric oxygen group,14 patients were treated with conventional therapy as conventional group,12 patients were treated with thrombolytic therapy as thrombolytic group,12 patients with hyperbaric oxygen and thrombolytic therapy were defined as hyperbaric oxygenated thrombolytic group.16 healthy volunteers,which had the matched age and sex,defined as normal group.Above four patient groups before and after treatment and normal group were given a bold-fMRI scan.The BOLD data were analyzed by regional homogeneity(ReHo)and amplitude of low-frequency fluctuation(ALFF).The t test of two samples was carried out by SPM8 software,and the P value was less than 0.05,the difference was statistically significant.Results:Compared with the normal group,the patients in conventional group,hyperbaric oxygen group,thrombolytic group,and hyperbaric oxygen thrombolysis group before treatment decreased part of brain region in ReHo and ALFF.Compared with before treatment,some brain areas of the four groups were partial activated in ReHo and ALFF.The activated brain areas changes in ReHo and ALFF of the conventional group,hyperbaric oxygen group,thrombolysis group and the hyperbaric oxygen thrombolysis group,which were before and after treatment,increased successively.Conclusion:There is abnormal with BOLD-fMRI in acute subcortical cerebral infarction.Some brain area can be reversed with hyperbaric oxygen and thrombolytic therapy.The reversal area of thrombolytic therapy is greater than that of hyperbaric oxygen therapy.The overall utilization of both is better.