腦梗死運動腦區結構和功能變化的MRI研究

汪洋+孟亮亮+秦文+于春水+張敬

[摘要] 目的 探討慢性期腦橋腦梗死患者運動相關腦區結構和功能變化。 方法 選擇2006年1月～2010年6月于天津醫科大學總醫院神經內科就診的16例慢性期腦橋腦梗死患者，選擇25例健康志愿者為對照組。采用3.0T磁共振掃描儀行全腦高分辨率解剖像及靜息態fMRI掃描。采用SPM8軟件對腦橋腦梗死組與對照組灰質體積行組間比較。將灰質體積存在差異的腦區定義為ROIs，進行基于ROIs的全腦水平rsFC分析。采用SPM8軟件對腦橋腦梗死組與對照組功能連接模式進行組間比較。 結果 與對照組相比，腦橋腦梗死組患者灰質體積縮小區為健側小腦半球后葉及蚓部（校正后P < 0.05，T峰值=-4.438）；灰質體積增加區為健側M1區（校正后P < 0.05，T峰值=4.4126）及雙側SMA（校正后P < 0.05，T峰值=4.7229）。與對照組相比，腦橋腦梗死組患者健側小腦半球與健側PMC（校正后P < 0.05，T峰值=4.1639）及雙側SMA（校正后P < 0.05，T峰值=4.4663，4.1639）連接增強；健側M1區與同側PMC連接增強（校正后P < 0.05，T峰值=3.8291），與同側小腦半球連接減弱（校正后P < 0.05，T峰值=-5.0192）；雙側SMA與健側中央后回（校正后P < 0.05，T峰值=3.9016）及雙側小腦半球（校正后P < 0.05，T峰值=4.1569，4.2991）連接增強。 結論 腦橋腦梗死可造成遠隔運動相關腦區結構改變；腦橋腦梗死既存在結構代償也存在功能代償。

[關鍵詞]腦梗死；灰質體積；靜息態功能連接；運動腦區

[中圖分類號] R743.3 [文獻標識碼] A [文章編號] 1673-7210（2017）03（a）-0099-04

MRI Study of structure and function within motor cortex in pontine stroke patients

WANG Yang MENG Liangliang QIN Wen YU Chunshui ZHANG Jing

Department of Radiology， Tianjin Medical University General Hospital， Tianjin 300052， China

[Abstract] Objective To investigate the changes of brain structure and function within related motor cortex area in patients with chronic pontine stroke. Methods From January 2006 to June 2010， 16 chronic pontine stroke patients in Department of Neurology of Tianjin Medical University General Hospital were enrolled， 25 healthy participants were enrolled as control group. High-resolution structural MRI and resting state fMRI of the whole brain were acquired by 3T MRI scanner. The gray matter volume between patients and control group were compared by SPM 8 software. The areas which were significantly different in gray matter volume were defined as ROIs. ROIs-based functional connectivity analysis in the global brain level were calculated. The functional connectivity maps of patients group and control group were compared by SPM 8. Results Compared with control group， the patients showed decreased gray matter volume in contralesional cerebellum and vermis （corrected P < 0.05， T peak = -4.438） and increased gray matter volume in contralesional M1 （corrected P<0.05， peak intensity=4. 4128） and bilateral SMA （corrected P < 0.05， T peak = 4.7229）. Compared with controls， the contralesional cerebellum had increased functional connectivity with contralesional PMC （corrected P < 0.05， T peak = 4.1639） as well as bilateral SMA （corrected P < 0.05， T peak = 4.4663， 4.1639）； the rsFC of contralesional M1 area with contralesional PMC was increased （corrected P < 0.05， T peak = 3.8291）， while decreased with contralesional cerebellum （corrected P < 0.05， T peak = -5.0192）； the rsFC of bilateral SMA both with contralesioinal post centralgyrus （corrected P < 0.05， T peak = 3.9016） and bilateral cerebellum （corrected P < 0.05， T peak = 4.1569，4.2991） were increased. Conclusion The structures in distant cerebral motor areas change in chronic pontine stroke patients. Compensative changes of both structure and function exist in chronic pontine stroke.