Effect Of BOLD-fMRI Imaging On RTMS In Treatment Of Upper Limb Dysfunction After Cerebral Infarction

Objective: The combination methods of measuring M1 area cortical thickness,fALFF ReHo and functional connection were used to study the structure and function changes of M1 area in patients with subacute ischemic stroke before and after treatment with rTMS in this study,then to explore the process and mechanism of rTMS on remodeling motor function of the brain after stroke in order to provide theoretical basis for guiding clinical practice.Methods: Thirty patients with primary cerebral infarction(single lesion,duration of 10-20days)were randomly divided into control group(taking neurology medical treatment and traditional rehabilitation therapy)and experimental group(based on the control group increased rTMS treatment).BOLD-f MRI resting and UE-FMA scores were performed on the day of admission and one course after admission(the fourth week of treatment)on both group of patients.Secondly,the M1 area of the lesioned hemisphere in patients were measured with using the Freesurfer V.5.1.0 software.Thirdly,the resting fMRI data were processed and analyzed by using Matlab2009 a comes with DPARSFA,REST plug-in to calculate the ReHo and fALFF values of M1 area in all subjects.Fourthly,we took the spherical area of experimental group and control group after treatment as ROI to connect with other voxels in the whole brain.The radius of spherical area is5 mm and the center mind is the peak point MNI coordinates where were the differences of cortical thickness of M1 area.Finally,we analyzed the differences of the ReHo value,fALFF value and FC results before and after treatment by using paired t test and double sample t test in REST controlling taking the gender,age and educational level of all subjects as the covariate in general linear model.And then we analyzed the correlation between UE-FMA and Re Ho.Results: There was a thickening change in the thickness of the cortex in the M1 area of the two groups through the treatment,and the experimental group was obvious(P <0.05).The ReHo values in the RIO region of the two groups reduced after treatment,while the experimental groupwas obvious(P <0.05).The ReHo values in the RIO region of the two groups reduced and the fALFF values increased after treatment,while the experimental group was obvious(P <0.05).The RIO and whole brain functional connection results show that:The enhanced areas by comparing the differences within the control group include the ipsilateral Temporal-Mid,Temporal-Inf,Frontal-sup,Frontal-Mid and the weakened areas include the contralateral Occipital-Inf,Cingulum and so on.The enhanced areas by comparing the differentences within the experimental group include the ipsilateral Temporal-Mid,Temporal-Inf and the weakened areas include the ipsilateral precentral,postcentral and bilateral SMA.The results of comparing the differences of the experimental group and the control group before and after treatment showed that there was a large area of connection weakened areas in the cerebellum and occipital lobe(using a single voxel threshold(P<0.05,uncorrected)with FDR corrected P<0.05 at the cluster level).The related analysis results of ReHo and UE-FMA scores showed that ReHo values were positively correlated with upper body motor function scores.Conclusions:(1)The cortical thickness of experimental group and control group of patients with ipsilateral M1 area thickened,the ReHo reduced and the fALFF increased after treatment.At the same time,the change of the experimental group was larger than that of the control group.These results and the results of functional connections confirmed that,the brain changed from the beginning of compensation to self-repair with the treatment intervention,and at the same time confirmed that rTMS play a catalytic role on the brain structure remodeling.(2)The ReHo value of the patients was positively correlated with the UE-FMA scores,indicating that the resting state fMRI technique based on ReHo can effectively evaluate the therapeutic effect of rTMS,and dynamically observe and predict the recovery of the patients.(3)It is an effective method to explore rTMS for improving the recovery mechanism of upper limb motor function in patients by using the combination of structure and function analysis to observe the M1 area changes of patients with cerebral infarction.