| Objective: To study the application value of Diffusion tensor imaging(DTI) and Diffusion tensor tractography(DTT) in the acute phase of cerebral infarction prognosis assessment, and by using DTI, to study the relationship between Wallerian degeneration with prognosis after infarction.Mmethods: Collect the cases of 39 patients with acute cerebral infarction, who were aged between 36 and 74. Twenty-three of them were male and sixteen female. They all received treatment in the neurology department in Xingtai People’s Hospital during the period of March to August in 2014. The average age is 61.23 ± 8.49. All these 39 patients with acute cerebral infarction had two DTI examinations, respectively within 72 hours and three weeks later after the onset. After being collected, the original data was transported into the Extended MR workspace2.6.3.4 workstation. By employing Fiber Track package provided by Philips, the pictures were analyzed and processed. The FA(fractional anisotropy, FA) values of the infarcts, the contralateral corresponding regional and bilateral cerebral peduncle lateral part were measured. Reconstruct the corticospinal tract of patients with acute cerebral infarction and do the classification. All these patients in the group received Methods muscle strength check(MMT) when they were admitted into the hospital and 3 months after onset, to determine the the grade of limb muscle strength. And according to the recovery of limb muscle strength, the patients were divided into three groups. Those whose muscle strength fully recovered to level 5 came to Group A; those whose muscle recovered partly but didn’t restore to level 5 came to Group B; those without recovery came to group C. With the help of SPSS 17.0 statistical analysis software the collected data was analyzed. By adopting paired t test, the FA values of the lesion side and the contralateral corresponding regional, the FA values of the same place from the first time to check and from the revision and the r FA of Group A, B and C was analyzed; by using Spearman correlation analysis, the relationship between the CST level of phase in cerebral infarction and the recovery level of strength was analyzed. P < 0.05 was regarded as the inspection standard.Results: It was recovered that, according to the findings from the examinations within 72 and three weeks, of all the 39 patients with acute cerebral infarction, the FA value within the infarcts, compared with the FA value of the contralateral normal brain tissue decreased significantly. After the paired t test, the differences between the FA values of the lesions and the FA value of the contralateral were statistically significant(P < 0.01). The average FA values of the lesions and the contralateral corresponding regional of the 39 patients with acute cerebral infarction were 0.210±0.039 and 0.386±0.045 respectively, reducing by 45.7%±9.8%; from three weeks after the onset to the subacute phase the average FA values of the lesion and the contralateral corresponding regional were 0.147±0.027 and 0.389±0.044 respectively, reducing by 62.1%±12.4%. Three weeks after the onset, the FA of the lesions compared with the first results, reduced further. After paired t test, the differences were statistically significant(P < 0.01), namely the FA value of lesions in subacute stage, compared with in the acute stage, reduced further. In the acute stage of cerebral infarction, of the 39 patients, 17 patients’ bilateral CST level belonged to Class 1, another 17 belonged to Class 2; and 5 belonged to Class 3. For example, after the Spearman rank correlation analysis, it is found that the level of the lateral corticospinal tract showed a negative correlation with the muscle recovery level, and the correlation coefficient was-0.687,P<0.05. That is to say, the higher the level was, the lower the recovery function of side limb motor was, and vice verse. In the acute stage of cerebral infarction, the average FA of the tract area with the lateral cerebral peduncle corticospinal and the contralateral corresponding area were 0.602±0.030 及 0.605±0.031. After paired t test, there was no statistical significance. Three weeks after onset, by reviewing DTI, it is found that the FA of infarcts remote cerebral peduncle,compared with that of the opposite side, reduced. The average FA of the affected side and the contralateral cerebral peduncle part were 0.482±0.050 and 0.603±0.030. After paired t test, the differences were statistically significant, reducing by 20.1%±7.5%. of the patients in the three groups were respectively, 0.867±0.040, 0.779±0.043 in Group B, 0.689±0.047 in Group C. All the cerebral peduncle r FA received paired t test, P < 0.05, with statistical significance. The cerebral peduncle r FA reduced gradually from Group A to group C. It was showed that the larger the r FA, the better the muscle recovery, and vice verse.Conclusion: In the process of the evolution of the cerebral infarction, the FA values of lesions change regularly, which gradually reduce as the course extend. In the acute stage of cerebral infarction, the damage degree of corticospinal tract is closely related to the patients’ muscle recovery level. Observing the integrity of the CST of acute cerebral infarction through DTT reconstruction can provide more powerful basis for the prognosis evaluation of the patients. Compared with Conventional impact means, DTI is able to find the occurrence of Wallerian degeneration sooner. In subacute phase, the lower the cerebral peduncle r FA of the affected side is, the heavier the denaturation degree is, which can provide quantitative indicators for the judgement of corticospinal tract injury. |
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