A Preliminary Study On The Effect Of Magnetic Resonance Imaging Navigated Repetitive Transcranial Magnetic Stimulation On Post Stroke Depression Evaluated By Diffusion Kurtosis Imaging Combined With Scale

Objective:The effect of magnetic resonance imaging navigated repetitive transcranial magnetic stimulation(rTMS)on post stroke depression(PSD)was evaluated by using diffusion kurtosis imaging(DKI)combined with the related clinical scales.The relationship between the changes of brain microstructure and PSD was discussed preliminarily,and the possible objective evaluation method of PSD was explored.Methods:The PSD patients who met the enrollment criteria were screened in the outpatient and inpatient departments of our hospital,and relevant demographic and stroke characteristics were collected.The patients were given 10 consecutive days of magnetic resonance navigation positioning rTMS treatment.All patients did not take drugs to intervene in mood during the enrollment period.Hamilton Depression Scale,Montgomery-Asberg Depression Rating Scale,Hamilton Anxiety Scale,Mini-mental state examination,Montreal cognitive assessment,Activity of Daily Living Scale and NIHSS were evaluated before and after treatment and 3D-T1 WI and DKI scans were completed.Using MRIcron and DKE software of our institute's MRI studio to process,we got the figure of anisotropy coefficient(FA)and mean kurtosis(MK),and selected 16 parts of frontal lobe,globus pallidus,putamen,caudate nucleus,thalamus,pedunculus cerebri,amygdala and hippocampus of bilateral cerebral hemisphere as the region of interest(ROI),and measure the corresponding FA,MK values.The changes that clinical scales and DKI parameters of brain ROI in PSD patients before and after treatment were analyzed.Results:(1)After treatment,the overall average scores of HAMD,MADRS and HAMA decreased by 4.33,8.33 and 3.00 points respectively,while the scores of MMSE,MoCA,ADL and NIHSS did not reach a consistent conclusion.(2)FA values of bilateral frontal lobes and thalamus in three patients were higher than those before treatment.(3)MK values of right frontal lobe and bilateral thalamus were lower than those before treatment.Conclusion:(1)That HAMD,MADRS and HAMA were used to evaluate the therapeutic effect of magnetic resonance imaging navigated rTMS on PSD,may be some inconsistencies,but there is a trend to improve the symptoms of depression and anxiety in PSD patients.(2)The effect of magnetic resonance imaging navigated rTMS on PSD may be related to the changes of the white matter microstructure in bilateral frontal lobe and thalamus,which suggests that the damage of the microstructure in frontal lobe and thalamus may be related to the pathogenesis of PSD.(3)DKI scanning technology can provide FA,MK and other parameters,provide a more accurate,more sensitive and more abundant imaging reference for exploring the brain microstructure damage of PSD patients,and it is hoped to become a visual and quantifiable objective evaluation method for PSD patients.