| Objective: To evaluate the degree of motor recovery in patients after ischemic stroke with the combination of DTI and f MRI. To probe the underlying mechanisms of motor recovery and brain reorganization in patients after ischemic stroke by observing the structural integrity of white matter tracts and cortical activity in brain.Methods : Randomly dividing patients diagnosed with subcortical stroke into two groups, which are rehabilitation group(contains 4 males and 2 females) and control group(contains 2 males and 2 females). All patients accept standard rehabilitation therapies at the start of being hospitalized. The course of therapies is 4 weeks during which five days per week and 60 minutes per time. In addition, rehabilitation group would accept an extra standard course of upper-extremity therapy in which 30 minutes per time consisted with the frequency of above course, and control group would accept an extra casual course of upper-extremity therapy at the same time. The same researcher would process the evaluation step, which consists of upper-extremity scores(Fugl-Meyer and ARAT) and functional neuroimaging(DTI and f MRI), in patients started from hospitalizing to the end of therapies. As we attain all datas from evaluation step, we would process the statistical analysis of all datas with SPSS 13.0. According to the sample is small, our method of statistical analysis would utilize non-parametric statistical tests.Results: 1. The FA values of ipsilesional lesioned region and PLIC in all patients decreased significantly when compared to the contralesional same region(P<0.001). 2. The active voxel counts of ipsilesional in all patients before accepting therapies increased significantly when compared to the contralesional side(P<0.01); The active voxel counts of ipsilesional and contralesional side in all patients after accepting a course of therapies increased significantly, and there is no difference( P>0.05). 3. The correlation coefficient between pre-therapeutic FA values in ipsilesional lesioned region and PLIC and upper-extremity scores(ARAT and Fugl-Meyer) are 0.964 and 0.939, and the differences are significant(P<0.001). 4. The correlation coefficient between pre-therapeutic LI values and upper-extremity scores(ARAT and Fugl-Meyer) are 0.794 and 0.673, and the differences are significant(P<0.05). 5. The pre-therapeutic values of LI, overall FA, ARAT and Fugl-Meyer in two groups are both significant different compared to the post-therapeutic values(P<0.05). 6. There is no significant differences between two groups in all Δ values except Fugl-Meyer test(P>0.05). 7. In all patients, The correlation coefficient of Δ LI values to Δ FA values of ipsilesional lesioned region and PLIC, Δa FA values of lesioned region are 0.758, 0.602 and-0.644; The correlation coefficient of Δ a FA values of lesioned region toΔa FA values of PLIC, ΔFugl-Meyer scores, ΔFA values of ipsilesional lesioned region and PLIC are 0.862,-0.746,-0.965 and-0.855; The correlation coefficient of Δa FA values of PLIC to ΔARAT scores, ΔFugl-Meyer scores, ΔFA values of ipsilesional lesioned region and PLIC are-0.784,-0.793,-0.891 and-0.929; The correlation coefficient ofΔARAT scores toΔFugl-Meyer scores andΔFA values of PLIC are 0.839 and 0.791; The correlation coefficient ofΔFugl-Meyer toΔFA values of ipsilesional lesioned region and PLIC are 0.737 and 0.874; The correlation coefficient of ΔFA values of ipsilesional lesioned region to PLIC is 0.892; All these correlation coefficient values are significant(P<0.05).Conclusions: 1. FA values derived from DTI is a potential biomarker for predicting motor outcomes in patients after ischemic stroke. Furthermore, it may contribute to probe the underlying re-structural mechanism of white matter integrity. 2. The changes in cortical activity may potential to clarify the relationship between motor recovery and brain reorganization. 3. The combination of multiple evaluations which is essential to the management in patients after stroke should be build efficiently. |
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