磁共振弥散张量成像在急性脑梗死的应用
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摘要
目的:急性脑梗死是一种严重危害人类健康的常见病,因此,对其早期确诊、明确病变部位、早期评估预后等有着非常重要的意义。磁共振弥散张量成像(diffusion tensor imaging,DTI)是近年来在常规磁共振成像(magnetic resonance imaging,MRI)和弥散加权成像(diffusion weighted imaging, DWI)基础上发展起来一种建立在水分子布朗运动理论基础上的新的成像技术。弥散张量纤维束成像(diffusion tensor tractography,DTT)是三维显示脑白质纤维束的一种无创性成像方法。这为脑梗死的早期诊断,精确定位及早期评估预后提供了可能。本研究通过分析45例急性脑梗死患者发病后MRI、DWI、DTI图像,研究梗死灶弥散张量参数变化,重建双侧皮质脊髓束(corticospinal tract,CST)并观察病灶与其空间关系,探讨DWI、DTI、DTT在急性脑梗死早期诊断、病变定位及早期评估预后的临床应用价值。
方法:选自2006.3~2007.12于我科住院的急性脑梗死患者45例,均具有不同程度的神经功能缺损,其中男性34例(75.6%),女性11例(24.4%),年龄42-87岁之间,平均年龄62.33±12.57岁,就诊时间为发病后4h~7d。根据患者病程分为:超早期(<12h)7例,急性期(12~24h)18例,亚急性期(>24h~7d)20例。入院时行头颅CT排除出血,然后应用Siemens Avanto1.5T磁共振机行头颅常规MRI (矢状位T1WI、T2WI,横轴位T1WI、T2WI)平扫、DWI及DTI检查,测量各期病灶和对侧相应脑组织的部分各向异性(fractional anistrophy,FA)、表观弥散系数(apparent diffusion coefficient,ADC);病灶的中心及周边各取直径为5mm的区域定义为中心区与边缘区,测定病灶中心区与边缘区FA值、ADC值;运用DTT进行CST三维成像,并将CST受累情况分为3级,1级:CST完整;2级:CST完整,但受压移位;3级:CST中断。在患者入院及治疗后2个月由神经内科医师依据美国国立卫生院脑卒中量表(National Institutes of Health Stroke Scale,NIHSS)对患者做神经功能评分,记录为NIHSS_((1))和NIHSS_((2))。所得资料应用SPSS13.0统计软件进行分析,计数资料采用配对χ~2检验,计量资料采用配对t检验,相关分析采用Spearman相关。
结果:
1 DWI及常规MRI检查结果
45例急性脑梗死患者均为右利手。DWI序列均发现责任病灶,阳性率为100%;常规MRI发现责任病灶40例,阳性率为88.89%,5例未被发现病灶的均为超早期患者。DWI阳性率较常规MRI高(χ~2=5.00,P<0.05)。
2 DTI参数在脑梗死不同病期的变化
(1)超早期患者7例,其病灶的FA均值为(0.429±0.052),对侧相应脑组织FA均值为(0.453±0.056),两侧比较无统计学意义;病灶的ADC均值为(0.354±0.051)×10~(-3)mm~2/s,对侧相应脑组织ADC均值为(0.408±0.045)×10~(-3)mm~2/s,两侧比较有统计学意义(t=6.599,P<0.01)。(2)急性期患者18例,其病灶的FA均值为(0.452±0.028),对侧相应脑组织FA均值为(0.500±0.030),两侧比较有统计学意义(t=10.885,P< 0.01);病灶的ADC均值为(0.328±0.036)×10~(-3)mm~2/s,对侧相应脑组织ADC均值为(0.377±0.029)×10~(-3)mm~2/s,两侧比较有统计学意义(t=14.386,P<0.01)。(3)亚急性患者20例,其病灶的FA均值为(0.398±0.047),对侧相应脑组织FA均值为(0.477±0.052),两侧比较有统计学意义(t=14.537,P< 0.01);病灶的ADC均值为(0.387±0.016)×10~(-3)mm~2/s,对侧相应脑组织ADC均值为(0.395±0.020)×10~(-3)mm~2/s,两侧比较无统计学意义。
3 DTI参数在梗死灶的中心区与边缘区的变化
(1)超早期患者病灶的中心区FA均值为(0.426±0.070),边缘区FA均值(0.434±0.049),两者比较无统计学意义;中心区ADC均值(0.306±0.074)×10~(-3)mm~2/s,边缘区ADC均值(0.362±0.062)×10~(-3)mm~2/s,两者比较有统计学意义(t=3.057, P<0.05)。(2)急性期患者病灶的中心区FA均值为(0.404±0.039),边缘区FA均值(0.463±0.030),两者比较有统计学意义(t=9.954,P<0.01);中心区ADC均值(0.289±0.036)×10~(-3)mm~2/s,边缘区ADC均值(0.374±0.024)×10~(-3)mm2 /s,两者比较有统计学意义(t=10.153,P<0.01)。(3)亚急性患者病灶的中心区FA均值为(0.360±0.042),边缘区FA均值(0.384±0.052),两者比较无统计学意义;中心区ADC均值(0.379±0.038)×10~(-3)mm~2/s,边缘区ADC均值(0.392±0.020)×10~(-3)mm~2/s,两者比较无统计学意义。
4梗死灶FA值与患者临床预后
所有患者入院时NIHSS_((1))评分在1~17之间,平均5.57±2.56;治疗后2个月NIHSS_((2))评分在0~12之间,平均2.33±2.47。梗死灶FA值降低百分比和NIHSS_((1))相关(r=0.500, P<0.05) ,和NIHSS_((2))评分无相关关系。
5皮质脊髓束三维成像
45例患者均行双侧皮质脊髓束三维成像,其中表现为1级的22例,2级的13例,3级的10例。皮质脊髓束的损伤程度与NIHSS_((2))相关(r=0.812,P<0.05)。
结论:
1 DWI、DTI可超早期诊断急性脑梗死,并精确定位。
2急性脑梗死患者,梗死灶DTI的参数在不同病期有不同的变化趋势,可协助临床分期。
3 DTI对缺血半暗带的判断有一定价值。
4梗死灶FA值下降幅度越大,患者的临床症状越严重。它可作为判断预后的客观指标之一。
5 DTT图像可判断病灶与皮质脊髓束的关系,分析病灶对皮质脊髓束的影响,可以作为早期评估患者预后的客观依据。
Objective: Acute cerebral infarction is a baneful common disease. So coming to diagnosis early and prognosis rationally play an important role in acute cerebral infarction. Magnetic resonance diffusion tensor imaging (DTI) based on conventional magnetic resonance imaging(MRI) and diffusion weighted imaging(DWI) is the water diffusion imaging technique devel- oped in rencent years. Diffusion tensor tractography(DTT),a new noninvasive technique, can help estimate the structural connectivity of the briar. Analyzing the characteristics of MRI、DWI and DTI in 45 patients with acute cerebral infarction in different phases, measuring the values of fractional anistro- phy(FA)、apparent diffusion coefficient(ADC) in different regions of interests(ROI) and performing bilateral corticospinal tract(CST) to explore the values of DTI in acute cerebral infarction.
Methods: Forty-five patients (mean age 62.33±12.57 years, range 42 to 87years old; male 34, female 11) presenting within 7days of the onset were studied. All the patients have neuro- logical impairment in some degree. According to the visiting time, hyper acute phase(<12h)n=7,acute phase(12~24h)n=18, subacute phase(>24h~7d)n=20. Patients with primary cerebral hemorrhage assessed by computed tomography(CT) were exclu- ded from the study. Conventional MRI (anteroposterior axes T1WI T2WI, abscissa axis T1WI T2WI)、DWI and DTI were performed on a Siemens Avanto 1.5T using a standard. The values of FA and ADC were measured in the infarcted regions, corresponding contralateral regions, and the central and peripheral parts in lesions. CST performed by DTT showed disrupted whose myodnamia was not or not completely recovered. The injured degree of CST in grade 1 was complete, grade 2 was complete but compression shift, grade 3 was break. All the patients were measured according to National Institutes of Health Stroke Scale(NIHSS) when on admission and two months after the onset. The statistics were made by SPSS 13.0, and P<0.05 is considered to have statistical difference. The difference between measurement data was decided by compared t-test, the difference between numeration data was assessed byχ~2 test, and the correlation analysis was taken by spearman correlation.
Results:
1 The comparison of the positive result between DWI and MRI(T2WI)
All of the 45 patients’are right handedness. All the lesions can be seen on DWI sequence, the positive rate of DWI in infarction detection was 100%. At the same time,only 40 patients were detected through T2WI and the positive rate was 88.89%. The other 5 patients who’s lesions were not undetected were in hyperacute phase. The contrastion showed that the posi- tive rate of DWI was higher than conventional MRI (χ~2=5.00, P<0.05).
2 The variation of the FA and ADC in different phases in infarction
ADC of lesions were significant in hyperacute and acute phase(P<0.01). FA of lesions were significant in acute and subacute phase(P<0.01).
3 The variation of the FA and ADC between the central and peripheral parts in lesions
Difference of FA between central and peripheral parts of lesions were significant in acute phase(P<0.01). Difference of ADC between central and peripheral parts of lesions were significant in hyperacute and acute phase(P<0.05).
4 The relationship between the value of FA and prognosis
All the patients' NIHSS score was average 5.57±2.56(rage 1 to 17) when on admission and was average 2.33±2.47(rage 0 to 12) two months after the onset. The decreasing percentage of FA value in infarctions has significant positive correlation with NIHSS_((1))(r=0.500,P<0.05), and has no correlation with NIHS S_((2)).
5 The condition of CST
The CST was created in each patient,and there were 22 cases of grade 1,13 cases of grade 2,10cases of grade 3.Injured degree of CST has significant positive correlation with NIHSS_((2)) (r=0.812, P<0.05).
Conclusion:
1 DWI、DTI are more sensible than conventional MRI in the diagnosis of hyperacute phase in cerebral infarction.
2 There is characteristic discipline in charges of FA and ADC in different phases of stroke and it is useful for staging.
3 DTT has important value to detect the ischemic penum- bra.
4 The larger the decreasing percentage of FA is, the more serious the clinical manifestation is. It can be considered as an objective index of prognosis.
5 Observing the condition of CST in patients with acute cerebral infarction and analyzing the relationship between the impairment of CST and lesions can prognosis early and object- ively.
方法:选自2006.3~2007.12于我科住院的急性脑梗死患者45例,均具有不同程度的神经功能缺损,其中男性34例(75.6%),女性11例(24.4%),年龄42-87岁之间,平均年龄62.33±12.57岁,就诊时间为发病后4h~7d。根据患者病程分为:超早期(<12h)7例,急性期(12~24h)18例,亚急性期(>24h~7d)20例。入院时行头颅CT排除出血,然后应用Siemens Avanto1.5T磁共振机行头颅常规MRI (矢状位T1WI、T2WI,横轴位T1WI、T2WI)平扫、DWI及DTI检查,测量各期病灶和对侧相应脑组织的部分各向异性(fractional anistrophy,FA)、表观弥散系数(apparent diffusion coefficient,ADC);病灶的中心及周边各取直径为5mm的区域定义为中心区与边缘区,测定病灶中心区与边缘区FA值、ADC值;运用DTT进行CST三维成像,并将CST受累情况分为3级,1级:CST完整;2级:CST完整,但受压移位;3级:CST中断。在患者入院及治疗后2个月由神经内科医师依据美国国立卫生院脑卒中量表(National Institutes of Health Stroke Scale,NIHSS)对患者做神经功能评分,记录为NIHSS_((1))和NIHSS_((2))。所得资料应用SPSS13.0统计软件进行分析,计数资料采用配对χ~2检验,计量资料采用配对t检验,相关分析采用Spearman相关。
结果:
1 DWI及常规MRI检查结果
45例急性脑梗死患者均为右利手。DWI序列均发现责任病灶,阳性率为100%;常规MRI发现责任病灶40例,阳性率为88.89%,5例未被发现病灶的均为超早期患者。DWI阳性率较常规MRI高(χ~2=5.00,P<0.05)。
2 DTI参数在脑梗死不同病期的变化
(1)超早期患者7例,其病灶的FA均值为(0.429±0.052),对侧相应脑组织FA均值为(0.453±0.056),两侧比较无统计学意义;病灶的ADC均值为(0.354±0.051)×10~(-3)mm~2/s,对侧相应脑组织ADC均值为(0.408±0.045)×10~(-3)mm~2/s,两侧比较有统计学意义(t=6.599,P<0.01)。(2)急性期患者18例,其病灶的FA均值为(0.452±0.028),对侧相应脑组织FA均值为(0.500±0.030),两侧比较有统计学意义(t=10.885,P< 0.01);病灶的ADC均值为(0.328±0.036)×10~(-3)mm~2/s,对侧相应脑组织ADC均值为(0.377±0.029)×10~(-3)mm~2/s,两侧比较有统计学意义(t=14.386,P<0.01)。(3)亚急性患者20例,其病灶的FA均值为(0.398±0.047),对侧相应脑组织FA均值为(0.477±0.052),两侧比较有统计学意义(t=14.537,P< 0.01);病灶的ADC均值为(0.387±0.016)×10~(-3)mm~2/s,对侧相应脑组织ADC均值为(0.395±0.020)×10~(-3)mm~2/s,两侧比较无统计学意义。
3 DTI参数在梗死灶的中心区与边缘区的变化
(1)超早期患者病灶的中心区FA均值为(0.426±0.070),边缘区FA均值(0.434±0.049),两者比较无统计学意义;中心区ADC均值(0.306±0.074)×10~(-3)mm~2/s,边缘区ADC均值(0.362±0.062)×10~(-3)mm~2/s,两者比较有统计学意义(t=3.057, P<0.05)。(2)急性期患者病灶的中心区FA均值为(0.404±0.039),边缘区FA均值(0.463±0.030),两者比较有统计学意义(t=9.954,P<0.01);中心区ADC均值(0.289±0.036)×10~(-3)mm~2/s,边缘区ADC均值(0.374±0.024)×10~(-3)mm2 /s,两者比较有统计学意义(t=10.153,P<0.01)。(3)亚急性患者病灶的中心区FA均值为(0.360±0.042),边缘区FA均值(0.384±0.052),两者比较无统计学意义;中心区ADC均值(0.379±0.038)×10~(-3)mm~2/s,边缘区ADC均值(0.392±0.020)×10~(-3)mm~2/s,两者比较无统计学意义。
4梗死灶FA值与患者临床预后
所有患者入院时NIHSS_((1))评分在1~17之间,平均5.57±2.56;治疗后2个月NIHSS_((2))评分在0~12之间,平均2.33±2.47。梗死灶FA值降低百分比和NIHSS_((1))相关(r=0.500, P<0.05) ,和NIHSS_((2))评分无相关关系。
5皮质脊髓束三维成像
45例患者均行双侧皮质脊髓束三维成像,其中表现为1级的22例,2级的13例,3级的10例。皮质脊髓束的损伤程度与NIHSS_((2))相关(r=0.812,P<0.05)。
结论:
1 DWI、DTI可超早期诊断急性脑梗死,并精确定位。
2急性脑梗死患者,梗死灶DTI的参数在不同病期有不同的变化趋势,可协助临床分期。
3 DTI对缺血半暗带的判断有一定价值。
4梗死灶FA值下降幅度越大,患者的临床症状越严重。它可作为判断预后的客观指标之一。
5 DTT图像可判断病灶与皮质脊髓束的关系,分析病灶对皮质脊髓束的影响,可以作为早期评估患者预后的客观依据。
Objective: Acute cerebral infarction is a baneful common disease. So coming to diagnosis early and prognosis rationally play an important role in acute cerebral infarction. Magnetic resonance diffusion tensor imaging (DTI) based on conventional magnetic resonance imaging(MRI) and diffusion weighted imaging(DWI) is the water diffusion imaging technique devel- oped in rencent years. Diffusion tensor tractography(DTT),a new noninvasive technique, can help estimate the structural connectivity of the briar. Analyzing the characteristics of MRI、DWI and DTI in 45 patients with acute cerebral infarction in different phases, measuring the values of fractional anistro- phy(FA)、apparent diffusion coefficient(ADC) in different regions of interests(ROI) and performing bilateral corticospinal tract(CST) to explore the values of DTI in acute cerebral infarction.
Methods: Forty-five patients (mean age 62.33±12.57 years, range 42 to 87years old; male 34, female 11) presenting within 7days of the onset were studied. All the patients have neuro- logical impairment in some degree. According to the visiting time, hyper acute phase(<12h)n=7,acute phase(12~24h)n=18, subacute phase(>24h~7d)n=20. Patients with primary cerebral hemorrhage assessed by computed tomography(CT) were exclu- ded from the study. Conventional MRI (anteroposterior axes T1WI T2WI, abscissa axis T1WI T2WI)、DWI and DTI were performed on a Siemens Avanto 1.5T using a standard. The values of FA and ADC were measured in the infarcted regions, corresponding contralateral regions, and the central and peripheral parts in lesions. CST performed by DTT showed disrupted whose myodnamia was not or not completely recovered. The injured degree of CST in grade 1 was complete, grade 2 was complete but compression shift, grade 3 was break. All the patients were measured according to National Institutes of Health Stroke Scale(NIHSS) when on admission and two months after the onset. The statistics were made by SPSS 13.0, and P<0.05 is considered to have statistical difference. The difference between measurement data was decided by compared t-test, the difference between numeration data was assessed byχ~2 test, and the correlation analysis was taken by spearman correlation.
Results:
1 The comparison of the positive result between DWI and MRI(T2WI)
All of the 45 patients’are right handedness. All the lesions can be seen on DWI sequence, the positive rate of DWI in infarction detection was 100%. At the same time,only 40 patients were detected through T2WI and the positive rate was 88.89%. The other 5 patients who’s lesions were not undetected were in hyperacute phase. The contrastion showed that the posi- tive rate of DWI was higher than conventional MRI (χ~2=5.00, P<0.05).
2 The variation of the FA and ADC in different phases in infarction
ADC of lesions were significant in hyperacute and acute phase(P<0.01). FA of lesions were significant in acute and subacute phase(P<0.01).
3 The variation of the FA and ADC between the central and peripheral parts in lesions
Difference of FA between central and peripheral parts of lesions were significant in acute phase(P<0.01). Difference of ADC between central and peripheral parts of lesions were significant in hyperacute and acute phase(P<0.05).
4 The relationship between the value of FA and prognosis
All the patients' NIHSS score was average 5.57±2.56(rage 1 to 17) when on admission and was average 2.33±2.47(rage 0 to 12) two months after the onset. The decreasing percentage of FA value in infarctions has significant positive correlation with NIHSS_((1))(r=0.500,P<0.05), and has no correlation with NIHS S_((2)).
5 The condition of CST
The CST was created in each patient,and there were 22 cases of grade 1,13 cases of grade 2,10cases of grade 3.Injured degree of CST has significant positive correlation with NIHSS_((2)) (r=0.812, P<0.05).
Conclusion:
1 DWI、DTI are more sensible than conventional MRI in the diagnosis of hyperacute phase in cerebral infarction.
2 There is characteristic discipline in charges of FA and ADC in different phases of stroke and it is useful for staging.
3 DTT has important value to detect the ischemic penum- bra.
4 The larger the decreasing percentage of FA is, the more serious the clinical manifestation is. It can be considered as an objective index of prognosis.
5 Observing the condition of CST in patients with acute cerebral infarction and analyzing the relationship between the impairment of CST and lesions can prognosis early and object- ively.
引文
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11 Guo AC, MacFall JR, Provenzale JM. Multiple sclerosis diffusion tensor MR imaging for evalution of normal appe-aring white matter.[J].Radiology, 2002,222(3): 729-736
12 Habas C. Basic principles of diffusion tensor MR trac-tography.[J].Journal de Radiologie,2004,85(3):281-286
13 Tench CR, Morgan PS, Wilson M, et al White matter mapping using diffusion tensor MRI.[J].Magnetic Reson-ance Medicine,2002,47(5):967-972
14 Parker GJ, Stephan KE, Barker GJ, et al Initial demonstration of in vivo tracing of axonal projections in the macaque brain and comparison with the human brainus-ing diffusion tensor imaging and fastmarching tractography.[J].Neuroimage,2002,15(4):797-809
15 Ciccarelli O, Parker GJ, Toosy AT,et al From diffusiontractography to quantitative white matter tract measures:arep reducibility study.[J].Neuroimage,2003,18(2):348-359
16 Ciccarelli O, Toosy AT, Parker GJ, et al. Diffusion tra-ctography based group mapping of major white matter pathways in the human brain.[J].Neuroimage,2003,19(4):1545-1555
17 Hagmann P, Thiran JP, Jonasson L,et al. DTI mapping of human brain connectivity:statistical fibre tracking andvirtual dissection.[J].Neuroimage,2003,19(3):545-554
18 康庄,卢广文,胡冰.三维脑白质纤维束示踪成像.解剖学研究,2007,29(3):198-201
19 Sorensen AG, Wu O, Copen WA, et al Human acute c-erebral ischemia: detection of changes in water diffusion anisotropy by using MR imaging.[J].Radiology,1999,212(3):785-792
20 O’Sullivan M, Morris RG, Huckstep B, et al Diffusion tensor MRI correlates with executive dysfunction in pat-ients with Ischemic leukoaraiosis.[J].Neurology,Neurosurgery&Psychiatry,2004,75(3):441-447
21 Werring DJ, Clack CA, Parker GJ,et al A direct demonstration of both structure and function in the visual sys-tem: combining diffusion tensor imaging with functionalmagnetic resonance imaging.[J].Neuroimage,1999,9(3):352-361
22 周钟珩,王德杭.DTI 在急性缺血性脑卒中所致皮质脊髓束损伤中的应用研究.医学影像学杂志,2007,17(1):23-27
23 徐铭玮,汪建文,罗本燕,等. 磁共振弥散张量成像在神经疾病中的应用.国外医学脑血管疾病分册,2005,13(7):506-509
24 梁志坚,曾进胜.脑梗死远隔区继发性损害的弥散张成像.国外医学脑血管疾病分册,2005,13(7):510-512
25 Nimsky C, Ganslandt Q, Hastreiter P,et al Intraoperativediffusion tensor MR imaging shifting of white matter t-acts during neurosurgical procedures-initial experience.[J].Radiology,2005,234(1):218-225
26 韩鸿宾,沙琳,刘洪东,等.快速多时相减影 CE2MRA 对头颈部 TOF2MRA 伪影的矫正.中国医学影像技术,2003,19(5):632~635
27 钟进,张云亭.MR 扩散张量成像在急性脑梗死的临床应用.中华放射学杂志,2005,39(7):677-681
28 Ringer TM, Neumann-Haefelin T, Sobel RA,et al Reve-rsal of early diffusion weighted magnetic resonance im-aging abnormalities does not necessarily reflect tissue s-alvage in experimental cerebral ischemia.[J].Stroke,2001,32(10):2362~2369
29 Yamada N, Imakita S, Sakuma T. Value of diffusion-weighted imaging and apparent diffusion coefficient in recent cerebral infarctions: a correlation study with contrastenhance T1-weighted imaging.[J]. American Journal of Neuroradiology,1999,20(2):193~198
30 Provenzale JM,Sorcensen AG.Diffusion-weighted MR im-aging in acute stroke: theoretic considerations and clini-cal applications.[J].American Journal of Neuroradiology,1999,173(6):1459~1467
31 崔世民,韩彤,刘力等.应用扩散张量和功能磁共振成像技术探讨皮质脊髓束与肌力的相关性.中国现代神经疾病杂志,2005,5(3):182-189
32 Werring DJ, Toosy AT, Clark CA,et al Diffusion tensor imaging can detect and quantify corticospinal tract deg-eneration after stroke.[J].Neurology,Neurosurgery&Psychi-atry,2000,69(2):269-272
33 Kunimatsu A, Aoki S, Masutani Y, et al Three-dimensi-onal white matter tractography by diffusion tensor ima-ging in ischemic stroke involving the corticospinal tract.[J].Neuroradiology,2003,45(8):532-535
34 Yamada K, Ito H, Nakamura H,et al Stroke patients' e-volving symptoms assessed by tractography.[J].Magnetic Resonance Imaging,2004,20(6):923-929
35 Jellison BJ, Field AS, Medow J, et al Diffusion tensor imaging of cerebral white matter: pictorial review of physics, fiber track anatomy, and tumor imaging patt- erns.[J].American Journal of Neuroradiology,2004,25(3): 356-369
36 崔谊,侯金文,孟祥水等.磁共振弥散张量成像对 Wallerian变性诊断价值的评价.山东大学学报(医学版),2006,44(7):746-749
37 Thomalla G, Glauche V, Koch MA, et al Diffusion ten-sor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke.[J].Neuroimage,2004,22(4):1767-1774
38 Thomalla G, Glauche V, Weiller C, et al Time course of wallerian degeneration after ischaemic stroke revealedby diffusion tensor Imaging.[J].Neurology,Neurosurgery&Psychiatry,2005,76:266-268
39 Maeda T, Ishizaki K, Yura S. Can diffusion tensor ima-ging predict the functional outcome of supratentorial stroke?[J].No To Shinkei.2005,57(1):27-32
40 Lee JS, Han MK, Kim SH, et al Fiber tracking by dif-fusion tensor imaging in corticospinal tract stroke:Topographical correlation with clinical symptoms.[J].Neuroima-ge,2005,26(3):771-776
41 Kunimatsu A, Aoki S, Masutani Y, et al Three-dimensional white matter tractography by diffusion tensor imaging in ischemic stroke involving thecorticospinal tract.[J].Neuroradiology,2003,45(8):532-535
42 Lie C, Hirsch JG, Rossmanith C, et al Clinicotopograp-hical correlation of cortical spinal tract stroke:a colorco-ded diffusion tensor imaging study.[J].Stroke,2004,35(1):86-92
43 王海燕,赵斌,于台飞等. DTI 在涉及皮质脊髓束缺血性脑梗塞中的应用.医学影像学杂志,2007,17(3):217-220
44 倪建明,沈天真,陈星荣等.采用纤维束成像研究皮质脊髓束损伤与脑梗死预后的关系.中国医学计算机成像杂志,2007,13(4):227-231
45 Melhem ER, Mori S, Mukundan G, et al Diffusion tensor MR imaging of the brain and white matter tractography.[J].American Journal of Roentgenology,2002,178(1):3-16
1 Bammer R, Acar B, Moseley ME. In vivo MR tractog-raphy using Diffusion imaging.[J].European journal of Radiology,2003,45(3):223-234
2 Lim KO, Hedehus MJ, Moseley ML,et al Compromisedwhite matter tract integrity in schizophrenia inferred fr-om diffusion tensor imaging.[J].Archives of General Ps-ychiatry,1999,56(4):367-374
3 肖江喜,郭雪梅,王霄英等.头部扩散张量磁共振成像扫描 方案的优选.中国医学影像技术,2003,19(11):1433-1435
4 Melhem ER,Itoh R, Jones L, et al Diffusion tensor MRof the brain:effect of diffusion weight on trace and an-isotropy measurement.[J].American Journal of Neurora-diology,2000,21(10):1813-1820.
5 北京磁共振脑成像中心.磁共振中心简报(总第三期),2004,5
6 Guo AC, MacFall JR, Provenzale JM.Multiple sclerosis diffusion tensor MR imaging for evalution of normala-ppearing white matter.[J].Radiology,2002,222(3):729-736
7 Jellison BJ, Field AS, Medow J, et al Diffusion tensor imaging of cerebral white matter:pictorial review of ph-ysics, fiber track anatomy, and tumor imaging patterns.[J].American Journal of Neuroradiology,2004,25(3):356-369
8 崔谊,侯金文,孟祥水等.磁共振弥散张量成像对 Wallerian变性诊断价值的评价.山东大学学报(医学版),2006,44(7):746-749
9 吴劲松,洪汛宁,周良辅等.白质纤维束的弥散张量成像在脑胶质瘤外科的应用.中国临床神经科学,2007,15(3):253-259
10 李贻卓,黄子林,魏一飞等.MR 弥散张量三维脑白质纤维束成像.南方医科大学学报,2007,27(8):1244-1250
11 乔梁,王汉东.磁共振弥散成像在弥漫性轴突损伤诊断中的应用.医学研究生学报,2007,20(10):1108-1111
12 Habas C. Basic principles of diffusion tensor MR trac-tography.[J].Journal de Radiologie,2004,85(3):281-286
13 Gossl C, Fahrmeir L, Putz B, et al Fiber tracking from DTI using linear state space models:detectability o-fthepyramidal tract.[J]Neuroimage,2002,16(2):378-388
14 Witwer BP, Moftakhar R, Hasan K, et al Diffusion te-nsor imaging of white matter tracts in patients with cerebral neoplasm.[J].Neurosurgery,2002,97(3):568-575
15 Jellison BJ, Field AS, Medow J, et al Diffusion tensorimaging of cerebral white matter: pictorial review of physics,fiber track anatomy,andtumor imaging patterns.[J].American Journal of Neuroradiology,2004,25(3):356-369
16 Werring DJ, Clack CA, Parker GJ, et al A direct de-monstration of both structure and function in the visu-alsystem: combining diffusion tensor imaging with functionalmagnetic resonance imaging.[J].Neuroimage,1999,9(3):352-361
17 梁志坚,曾进胜.脑梗死远隔区继发性损害的弥散张成像.国外医学脑血管疾病分册,2005,13(7):510-512
18 Nimsky C, Ganslandt Q, Hastreiter P, et al Intraoperat-ive diffusion tensor MR imaging shifting of white ma-tter tracts during neurosurgical procedures-initial expe-rience.[J].Radiology,2005,234(1):218-225
19 O’Sullivan M, Morris RG, Huckstep B, et al Diffusiontensor MRI correlates with executive dysfunction inpatients with Ischemic leukoaraiosis.[J].Neurology Neur-osurgery&Psychiatry,2004,75(3):441-447
20 Thomalla G, Glauche V, Koch MA, et al Diffusion ten-sor imaging detects early Wallerian degeneration of thepyramidal tract after ischemic stroke.[J].Neuroimage,2004,22(4):1767-1774
21 Thomalla G, Glauche V,Weiller C, et al Time course ofwallerian degeneration after ischaemic stroke revealed by diffusion tensor Imaging.[J].Neurology Neurosurgery&P-sychiatry,2005,76(2):266-268
22 Kunimatsu A, Aoki S, Masutani Y,et al Three-dimensional white matter tractography by diffusion tensor imaging in ischemic stroke involving the corticospinal tract.[J].Neuroradiology,2003,45(8):532-535
23 Lie C, Hirsch JG, Rossmanith C, et al Clinicotopogra-phical correlation of corticospinal tract stroke:a color-coded diffusion tensor imaging study.[J].Stroke,2004,35(1):86-92
24 Herve D, Molko N, Pappata S, et al Longitudinal thalamic diffution changes after middle cerebral artery infarcts.[J].Neurology,Neurosurgery&Psychiatry,2005,76(2):200-205
25 Maeda T, Ishizaki K, Yura S. Can diffusion tensor imag-ing predict the functional outcome of supra tentorial stroke?No To Shinkei,2005,57(1):27-32
26 钟进,张云亭.MR 扩散张量成像在急性脑梗死的临床应用.中华放射学杂志 2005,39(7):677-681
27 Jang SH, Kwon YH, Lee MY. Corticospinal tract com-pression by hematoma in a patient with intracerebral h-emorrhage:a diffusion tensor tractography and functionalMRI study.[J].Yonsei Medical Journal,2006,47(1):135-139
28 陈丽萍,吴卫平,郑奎洪.多发性硬化患者智能改变与头颅磁共振成像测量及弥散张量成像研究.中华神经科杂志,2004,37(2):118-121
29 Gallo A, Rovaris M, Riva R, et al Diffusion tensor m-agnetic resonance imaging detects normal-appearing whi-te matter damage unrelated to short-term disease active-ty in patients at the earliest clinical stage of multiple s-clerosis.[J].Archives of Neurology,2005,62(5):803-808
30 Sinha S, Bastin ME, Whittle IR, et al Diffusion tensor MR imaging of high-grade cerebral gliomas.[J].AmericanJournal of Neuroradiology,2002,23(4):520-527
31 Lu S, Ahn D, Johnson G.Peritumoral diffusion tensor i-maging of highgrade gliomas and metastatic brain tum-ors.[J].American Journal of Neuroradiology,2003,24(5):937-941
32 Beppu T, Inoue T, Shibata Y, et al Measurement of fr-actional anisotropy using diffusion tensor MRI in supra-tentorial astrocytic tumours.[J].Neurooncol,2003,63(1):109-116
33 Price SJ, Pena A, Burnet NG, et al Detecting glioma i-nvasion of the corpus callosum using diffusion tensor i-maging.[J].Neurosurg,2004,18(4):391-395
34 Mukherjee P, Miller J, Shimony J, et al Normal brain maturation during childhood developmental trends chara-cterized with diffusion tensor MR imaging.[J].Radiology,2001,221(2):349-358
35 Filippi CG, Lin DD, Tsiouris AJ, et al Diffution tensorMR imaging children with developmental delay:prelimi-nary findings.[J].Radiology,2003,229(1):44-50
36 崔世民,韩彤,刘力等.应用扩散张量和功能磁共振成像技术探讨皮质脊髓束与肌力的相关性.中国现代神经疾病杂志,2005,5(3):182-189
37 Luft AR, Mc Combe, Waller S, Whitall J, et al Repeti-tive bilateral arm training and motor cortex activation i-nchronic stroke:a randomized controlled trial.[J].JAMA,2004,292(15):1853-1861
38 Masutani Y, Aoki S, Abe O, et a1 MR diffusion tensorimaging:recent advance and new techniques for diffusio-n tensor visualization.[J].European Journal of Radiology,2003,46(1):53-66
2 粟秀初,孔繁元,范学文,主编.现代脑血管病学.北京:人民军医出版社,2003,161
3 肖慧,陈自谦,张碧云等.三维纤维束示踪成像评价急性脑梗死患者皮质脊髓束损伤的意义.中国临床康复,2006,10(34):70-72
4 Pierpaoli C, Jezzard P, Basser PJ, et al Diffusion tensor MR imaging on the human brain. Radiology,1996,201(3):637-648
5 Gillard JH, Papadakis NG, Martin K,et al MR diffusion tensor imaging of white matter tract disruption in stroke at 3T.[J].British Journal Radiology,2001,74(883):642-647
6 吴劲松,洪汛宁,周良辅等.白质纤维束的弥散张量成像在脑胶质瘤外科的应用.中国临床神经科学,2007,15(3):253-259
7 李贻卓,黄子林,魏一飞等.MR 弥散张量三维脑白质纤维束成像.南方医科大学学报,2007,27(8):1244-1250
8 乔梁,王汉东.磁共振弥散成像在弥漫性轴突损伤诊断中的应用.医学研究生学报,2007,20(10):1108-1111
9 Barrick TR, Clark CA. Singularities in diffusion tensor fields and their relevance in white matter fiber tractog-raphy.[J].Neuroimage,2004,22(2):481-491
10 Klose U, Mader I, Unrath A, et al Directional correla-tion in white matter tracks of the human brain.[J].Ma-gnetic Resonance Imaging,2004,20(1):25-30
11 Guo AC, MacFall JR, Provenzale JM. Multiple sclerosis diffusion tensor MR imaging for evalution of normal appe-aring white matter.[J].Radiology, 2002,222(3): 729-736
12 Habas C. Basic principles of diffusion tensor MR trac-tography.[J].Journal de Radiologie,2004,85(3):281-286
13 Tench CR, Morgan PS, Wilson M, et al White matter mapping using diffusion tensor MRI.[J].Magnetic Reson-ance Medicine,2002,47(5):967-972
14 Parker GJ, Stephan KE, Barker GJ, et al Initial demonstration of in vivo tracing of axonal projections in the macaque brain and comparison with the human brainus-ing diffusion tensor imaging and fastmarching tractography.[J].Neuroimage,2002,15(4):797-809
15 Ciccarelli O, Parker GJ, Toosy AT,et al From diffusiontractography to quantitative white matter tract measures:arep reducibility study.[J].Neuroimage,2003,18(2):348-359
16 Ciccarelli O, Toosy AT, Parker GJ, et al. Diffusion tra-ctography based group mapping of major white matter pathways in the human brain.[J].Neuroimage,2003,19(4):1545-1555
17 Hagmann P, Thiran JP, Jonasson L,et al. DTI mapping of human brain connectivity:statistical fibre tracking andvirtual dissection.[J].Neuroimage,2003,19(3):545-554
18 康庄,卢广文,胡冰.三维脑白质纤维束示踪成像.解剖学研究,2007,29(3):198-201
19 Sorensen AG, Wu O, Copen WA, et al Human acute c-erebral ischemia: detection of changes in water diffusion anisotropy by using MR imaging.[J].Radiology,1999,212(3):785-792
20 O’Sullivan M, Morris RG, Huckstep B, et al Diffusion tensor MRI correlates with executive dysfunction in pat-ients with Ischemic leukoaraiosis.[J].Neurology,Neurosurgery&Psychiatry,2004,75(3):441-447
21 Werring DJ, Clack CA, Parker GJ,et al A direct demonstration of both structure and function in the visual sys-tem: combining diffusion tensor imaging with functionalmagnetic resonance imaging.[J].Neuroimage,1999,9(3):352-361
22 周钟珩,王德杭.DTI 在急性缺血性脑卒中所致皮质脊髓束损伤中的应用研究.医学影像学杂志,2007,17(1):23-27
23 徐铭玮,汪建文,罗本燕,等. 磁共振弥散张量成像在神经疾病中的应用.国外医学脑血管疾病分册,2005,13(7):506-509
24 梁志坚,曾进胜.脑梗死远隔区继发性损害的弥散张成像.国外医学脑血管疾病分册,2005,13(7):510-512
25 Nimsky C, Ganslandt Q, Hastreiter P,et al Intraoperativediffusion tensor MR imaging shifting of white matter t-acts during neurosurgical procedures-initial experience.[J].Radiology,2005,234(1):218-225
26 韩鸿宾,沙琳,刘洪东,等.快速多时相减影 CE2MRA 对头颈部 TOF2MRA 伪影的矫正.中国医学影像技术,2003,19(5):632~635
27 钟进,张云亭.MR 扩散张量成像在急性脑梗死的临床应用.中华放射学杂志,2005,39(7):677-681
28 Ringer TM, Neumann-Haefelin T, Sobel RA,et al Reve-rsal of early diffusion weighted magnetic resonance im-aging abnormalities does not necessarily reflect tissue s-alvage in experimental cerebral ischemia.[J].Stroke,2001,32(10):2362~2369
29 Yamada N, Imakita S, Sakuma T. Value of diffusion-weighted imaging and apparent diffusion coefficient in recent cerebral infarctions: a correlation study with contrastenhance T1-weighted imaging.[J]. American Journal of Neuroradiology,1999,20(2):193~198
30 Provenzale JM,Sorcensen AG.Diffusion-weighted MR im-aging in acute stroke: theoretic considerations and clini-cal applications.[J].American Journal of Neuroradiology,1999,173(6):1459~1467
31 崔世民,韩彤,刘力等.应用扩散张量和功能磁共振成像技术探讨皮质脊髓束与肌力的相关性.中国现代神经疾病杂志,2005,5(3):182-189
32 Werring DJ, Toosy AT, Clark CA,et al Diffusion tensor imaging can detect and quantify corticospinal tract deg-eneration after stroke.[J].Neurology,Neurosurgery&Psychi-atry,2000,69(2):269-272
33 Kunimatsu A, Aoki S, Masutani Y, et al Three-dimensi-onal white matter tractography by diffusion tensor ima-ging in ischemic stroke involving the corticospinal tract.[J].Neuroradiology,2003,45(8):532-535
34 Yamada K, Ito H, Nakamura H,et al Stroke patients' e-volving symptoms assessed by tractography.[J].Magnetic Resonance Imaging,2004,20(6):923-929
35 Jellison BJ, Field AS, Medow J, et al Diffusion tensor imaging of cerebral white matter: pictorial review of physics, fiber track anatomy, and tumor imaging patt- erns.[J].American Journal of Neuroradiology,2004,25(3): 356-369
36 崔谊,侯金文,孟祥水等.磁共振弥散张量成像对 Wallerian变性诊断价值的评价.山东大学学报(医学版),2006,44(7):746-749
37 Thomalla G, Glauche V, Koch MA, et al Diffusion ten-sor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke.[J].Neuroimage,2004,22(4):1767-1774
38 Thomalla G, Glauche V, Weiller C, et al Time course of wallerian degeneration after ischaemic stroke revealedby diffusion tensor Imaging.[J].Neurology,Neurosurgery&Psychiatry,2005,76:266-268
39 Maeda T, Ishizaki K, Yura S. Can diffusion tensor ima-ging predict the functional outcome of supratentorial stroke?[J].No To Shinkei.2005,57(1):27-32
40 Lee JS, Han MK, Kim SH, et al Fiber tracking by dif-fusion tensor imaging in corticospinal tract stroke:Topographical correlation with clinical symptoms.[J].Neuroima-ge,2005,26(3):771-776
41 Kunimatsu A, Aoki S, Masutani Y, et al Three-dimensional white matter tractography by diffusion tensor imaging in ischemic stroke involving thecorticospinal tract.[J].Neuroradiology,2003,45(8):532-535
42 Lie C, Hirsch JG, Rossmanith C, et al Clinicotopograp-hical correlation of cortical spinal tract stroke:a colorco-ded diffusion tensor imaging study.[J].Stroke,2004,35(1):86-92
43 王海燕,赵斌,于台飞等. DTI 在涉及皮质脊髓束缺血性脑梗塞中的应用.医学影像学杂志,2007,17(3):217-220
44 倪建明,沈天真,陈星荣等.采用纤维束成像研究皮质脊髓束损伤与脑梗死预后的关系.中国医学计算机成像杂志,2007,13(4):227-231
45 Melhem ER, Mori S, Mukundan G, et al Diffusion tensor MR imaging of the brain and white matter tractography.[J].American Journal of Roentgenology,2002,178(1):3-16
1 Bammer R, Acar B, Moseley ME. In vivo MR tractog-raphy using Diffusion imaging.[J].European journal of Radiology,2003,45(3):223-234
2 Lim KO, Hedehus MJ, Moseley ML,et al Compromisedwhite matter tract integrity in schizophrenia inferred fr-om diffusion tensor imaging.[J].Archives of General Ps-ychiatry,1999,56(4):367-374
3 肖江喜,郭雪梅,王霄英等.头部扩散张量磁共振成像扫描 方案的优选.中国医学影像技术,2003,19(11):1433-1435
4 Melhem ER,Itoh R, Jones L, et al Diffusion tensor MRof the brain:effect of diffusion weight on trace and an-isotropy measurement.[J].American Journal of Neurora-diology,2000,21(10):1813-1820.
5 北京磁共振脑成像中心.磁共振中心简报(总第三期),2004,5
6 Guo AC, MacFall JR, Provenzale JM.Multiple sclerosis diffusion tensor MR imaging for evalution of normala-ppearing white matter.[J].Radiology,2002,222(3):729-736
7 Jellison BJ, Field AS, Medow J, et al Diffusion tensor imaging of cerebral white matter:pictorial review of ph-ysics, fiber track anatomy, and tumor imaging patterns.[J].American Journal of Neuroradiology,2004,25(3):356-369
8 崔谊,侯金文,孟祥水等.磁共振弥散张量成像对 Wallerian变性诊断价值的评价.山东大学学报(医学版),2006,44(7):746-749
9 吴劲松,洪汛宁,周良辅等.白质纤维束的弥散张量成像在脑胶质瘤外科的应用.中国临床神经科学,2007,15(3):253-259
10 李贻卓,黄子林,魏一飞等.MR 弥散张量三维脑白质纤维束成像.南方医科大学学报,2007,27(8):1244-1250
11 乔梁,王汉东.磁共振弥散成像在弥漫性轴突损伤诊断中的应用.医学研究生学报,2007,20(10):1108-1111
12 Habas C. Basic principles of diffusion tensor MR trac-tography.[J].Journal de Radiologie,2004,85(3):281-286
13 Gossl C, Fahrmeir L, Putz B, et al Fiber tracking from DTI using linear state space models:detectability o-fthepyramidal tract.[J]Neuroimage,2002,16(2):378-388
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