Bold-the Fmri Combined With Dti In A Preliminary Study On The Mechanism Of Limb Motor Function Recovery After Ischemic Stroke

Part One:Hemiplegic upper limb early passive movement Bold-fMRI imaging in the evaluation of clinical outcomeObjective: To study complete unilateral upper extremity paralysis due to stroke in patients with early passive stretching finger grip (FE, finger extension) the task of intracranial Bold-fMRI imaging performance and the association of motor function recovery .Methods: 19 patients with initial onset of acute cerebral infarction and non-M1 cortex of partial unilateral severe upper body exercise disorders (muscle strength gradeⅠor less), under the 1.5T MR, the fMRI was performed using finger passive flexion-extention (FE)movement paradigm. observation and analysis by SPM5 stroke intracranial sensorimotor cortex(SMC), The supplementary motor area( SMA), premotor area(PM ), posterior parietal cortex( PPC) functional activation. Record the Fugl-Meyer arm motor function score in the first and third month.Results: According early fMRI performance three type was divided: I type in the main affected side, bilateral SMC and SMA was activated. type II simple ipsilateral SMC and SMA area activated; type III bilateral SMC no significantly activated.Type I 8 cases, immediate FM rate was 4.5+4.5 points, in first month upper limb function nearly full recovery, FM rate 47.1+5.5 , in the third month the FM rate was 61.1+3.8. type II 6 cases, immediate FM score was 4.7 +5.1, in first month the upper limb motor FM score 36+6.7, in the third month FM score was 59 +5.2; typeⅢ5 cases, immediate FM score was 6.2 +4.1 points, in the first month the upper limb movement FM score was 11.2+3.1 points, poor recovery of upper limb function after March, FM score was 10.8 +5.6 .Conclusion: Upper extremity hemiplegia in early passive movement Bold-fMRI imaging can early access the patient's clinical prognosis of and guide clinical treatment. Part Two: the longitudinal magnetic resonance imaging study of ischemic stroke hemiplegic upper-limb motor function recovery -Combined Bold-fMRI and DTI techniqueObjective: To investigate the correlation of cerebral function reorganization , functional recovery and the fiber bundle injury by using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging longitude study of upper-limb hemiparesis in ischemic stroke.Methods: 15 patients with initial onset of acute cerebral infarction accompanied upper-limb hemiparesis (upper limb muscle strength of gradeⅢor less), one week after onset, respectively, a month and three months, in the 1.5T MR to investigate the finger extension(FE) Bold-fMRI examination, Use the software of SPM5 to observe and analyse the different stages of post-stroke brain The sensorimotor cortex( SMC), The supplementary motor area(SMA) ,premotor area(PM), parietal cortex cortex(PPC) functional activation. Meanwhile, on the subjects Departed diffusion tensor magnetic resonance imaging to calculate and measure the ipsilateral CST damaged area and the corresponding region of the contralateral CST FA value and the ADC value, and rebuild the FA map, direction encoded color map, bilateral CST 3D fiber bundle map. And compare the number of muscle fibers and circumstances FA values, ADC values were observed. Region of interest set by observation of ipsilateral corticospinal tract (CST) of damage, calculated by the software, access to the affected side and the relative number of entries remaining CST contralateral CST FA values and the number of entries and the FA value and calculate the FA index (affected side FA value / contralateral FA value), ADC index (ipsilateral ADC value / contralateral ADC value). Meanwhile, three cases of healthy adult volunteers in the same task fMRI and DTI scan, and as a function of the control group. Upper limbs were recorded during the different examination FM (Fugl-Meyer) motor scores. Results: DTI imaging according to the patients after the first reconstruction of the remaining fibers ipsilateral contralateral ratio of the amount and divided into three types. typeⅠthe affected side is larger than the contralateral fibers root 2 / 3, typeⅡipsilateral fibers bundle is larger than the contralateral root 1 / 3 but less than 2 / 3, typeⅢaffected side is smaller than the contralateral fibers root 1 / 3. TypeⅠperformers Residual DTT showed the number of ipsilateral and contralateral CST was no significant difference in fiber bundles, no significant damage and disruption, diffusion tensor imaging showed ipsilateral posterior limb of internal capsule along with the progression of FA index gradually reduced, while ADC index increased gradually. This type of early Bold-fMRI study showed, finger movement to the affected side dominated bilateral SMC and SMA areas significantly activated areas, one month and three months of bilateral hemisphere SMC and SMA activation area is still visible, but With the recovery of the injured muscle strength, decreased activation of the contralateral hemisphere SMC, ipsilateral hemisphere, gradually increased SMC activation, ipsilateral hemisphere activated in SMC area and volume with no correlation between the injured arm strength. The first and third month were followed up for mean FM score 47.12+5.5 points and 61.1 +3.8points. TypeⅡperformers DTI showed affected side CST compared with the healthy side reduce t more than 1 / 3, both were significantly different (p <0.05). posterior limb of internal capsule along with the progression of FA index gradually reduced, while the ADC index increased gradually. This type of early Bold-fMRI study case showed, upper-limb movement ipsilateral SMC and SMA areas strongly activated, contralateral SMC, SMA activation was not obvious, one month was dominated by the contralateral bilateral SMC and SMA area area activated, at the same time bilateral PPC also significant activated. Third months of bilateral hemisphere SMC and SMA activation area is still visible, but with the risk of recovery of hand muscle strength, decreased activation of the contralateral hemisphere SMC, ipsilateral hemisphere SMC activation increased, PPC activation persists. This type of FM patients were followed up in first and third month score was 36+5.2 points and 59+6.7 points. TypeⅢDTT showed ipsilateral CST damage and disruptionsignificanly, and the posterior limb of internal capsule ipsilateral FA values significantly lower than the healthy side (p <0.01). When this type of case in first month a mild activation of contralateral SMC area, the health area ipsilateral SMC and SMA were no significantly activated. The first and third month of this type of follow-up FM score was 11.2+5.6 points and 10.8 +3.1 points.Conclusion: Bold-fMRI combined DTI technology longitudinal study of stroke patients initially, image, three-dimensional sets out the process and mechanism of patients with ischemic stroke upper-limb motor disability, and the comprehensive assessment the prognosis of rehabilitation and has important clinical significance.