A Preliminary Study On The Mechanism Of BOLD-fMRI Combined With DTI Technique In The Recovery Of Limb Motor Dysfunction

Part One:A preliminary fMRI study of acupuncturing Hegu and Waiguan in healthy volunteersObjective:To observe the cortical functional distributions of healthy volunteers acupunctured Hegu and Waiguan by using BOLD-fMRI technique,furthermore, to explore the neural mechanism of acupuncture by using it.Methods:According to the inclusion criteria,18healthy volunteers acupunctured left Hegu and Waiguan have been examinated on Block mode BOLD-fMRI, processing data using software such as SPM8, distributions of functional brain activation in healthy volunteers have been observed and analyzed,including excited zones and zones of inhibition. We have payed key attention to the related brain regions of motor function.Results:The positive correlation activated brain areas of acupuncturing volunteers showed that, in the left excited brain regions,the left middle frontal gyrus and inferior frontal gyrus(BA8,9,10,45,47) had significantly active regions. There were a large number of the active regions in the left insula (BA13,14,15).In addition, it also can be seen a small amount of the active regions in the left cerebellum, the left precentral gyrus (BA4,6), the left postcentral gyrus (BA2),the left inferior parietal lobule (BA40), the left medial frontal gyrus (BA8), the left precuneus (BA17,18), the left anterior cingulate gyrus (BA24), the left claustrum. The right side of the brain excited mainly were distributed in the right middle frontal gyrus (BA6,8,9,10,46) and the right medial frontal gyrus (BA6,32); Moreover, the right inferior parietal lobule (BA40) and right precentral gyrus (BA4,6) were actived in some extent. There were a small amount of activation in the right middle temporal gyrus, the right superior temporal gyrus (BA21,22), the right insula (BA13), and right inferior frontal gyrus (BA45,47) and the right postcentral gyrus (BA1,2,3,40).The negative correlation analysis showed that, Negative active regions were mainly located on both sides of the limbic lobe, including the hippocampus, parahippocampal gyrus (BA35,36) and cingulate gyrus (BA23,24,31).The left superior temporal gyrus, the left middle temporal gyrus (BA38) and the right middle frontal gyrus (BA46) also see a small negative activation zone distributed.Conclusion:In brain regions associated with motor function,in addition to partial activations of the contralateral primary sensorimotor area, the bilateral activations of secondary motor areas can be seen clearly,there are some activation in ipsilateral cerebellum.Perhaps it is the neuropathological basis as motor dysfunction disease treatment of acupoints.BOLD-fMRI imaging can display neural effects under physiological condition of acupuncture intuitively,and it can be as the basis and control of further study what influences on acupuncture human reaction are when nerve fibers are damaged.Part Two:To evaluate the influences on neurological effects of acupuncture due to damaging to the nerve fiber bundles by combining BOLD-fMRI and DTI techniqueObjective: To observe the neural effects of acupuncture when the bundle of nerve fibers are damaged, to evaluate what the influences on neural effects of acupuncture are due to damage to nerve fibers,and to explore the recovery mechanisms of limb motor function of stroke patients who received the acupuncture.Methods:10patients with initial onset of stroke in the left upper side of the body movement-based dysfunction (upper limbs less than or equal grade IV) have been examinated in the3.0T MR at3-6weeks after the onset of stroke, including DTI and BOLD-fMRI of acupuncturing left Hegu and Waiguan.Respectively, the damages to the right CST were showed through the reconstruction of bilateral CST3D fiber bundles by post-processing workstation, and the distributions of functional brain activation after stroke were observed and analyzed by SPM8software. Before the experiments, a professional rehabilitation physician had graded, scored and recorded the left upper limb muscle strength of patients by MRC muscle strength rating system and the simplified FM (Fugl-Meyer) scoring system.Results:DTI and DTT technique intuitively, three-dimensionally,visually showed that the right CST of10stroke patients were subjected to different degrees of damage, interruption, pressure, displacement and other changes.BOLD-fMRI study showed that, the most excited and obvious brain regions of acupuncture in stroke patients were mainly located on bilateral basal ganglia nuclei and thalamus. The left medial frontal gyrus, the left superior frontal gyrus (BA6,8,11) and left insula (BA13,14,15) had significantly active regions.There were a large number of excited regions in Midbrain reticular formation, red nucleus, substantia nigra and left cerebellum hillside, dentate nucleus, the right prefrontal cortex (BA6,8,9,10,45,47).There were partial excited regions in Bilateral anterior cingulate gyrus (BA24,32). In addition, there were a small amount of the active regions in the left inferior temporal gyrus, fusiform gyrus (BA20,37), the left middle frontal gyrus (BA6), the left inferior frontal gyrus (BA45), bilateral anterior precuneus (BA17), the right cerebellum hillside and right parietal cortex (BA7).The negative excited brain regions included the left posterior cingulate gyrus (BA30,32), the right occipital lobe (BA18,19) and right superior frontal gyrus (BA11).Conclusion:BOLD-fMRI combined DTI technology on acupuncture preliminarily, intuitively, three-dimensionally, visually displays the neural effects of acupuncture when nerve fibers are damaged,it evaluates the influence of the acupunctural neural effects due to damaging to nerve fibers, and it explains the recovery mechanism on limb motor function of stroke for acupuncture, it can forecast even evaluate the time for intervention and clinical prognosis of acupuncture, which has important directive significance to clinical rehabilitation.