| Object: The study aims to compare glucose metabolism of region of interest (ROI) between integrative rehabilitation group and non-rehabilitation group in use of positron emission computed tomography (PET-CT), thus to illustrate changes of motor regions between the two groups, and to discuss effects of rehabilitation by analyzing the glucose metabolism differences of activating regions between the two groups.Material and methods: eight male patients with hemiparesis were chosen who were diagnosed with cerebral hemorrhage or cerebral infarction by CT or MRI according to cerebrovascular disease classification criteria made in 4th national cerebrovascular disease conference in 1995. Also they met following criteria:①stroke(including cerebral hemorrhage and cerebral infarction)patients in basal nucleus;②<1month after stroke;③life signs were stabilized;④GCS grades>8;⑤35≤age≤80;⑥with limb hemiparesis. Patients were put into two groups: 6 in rehabi-group, aged from 47 to 72, average 59.5±11.5years; 2 in control-group, aged from 57 to 60 ,average 58.5years, there were no significant difference in ages between the two groups (P>0.05). Patients receive fugel-meyer assessment,Bather index (rectified),lesion of brain function the day before PET-CT scanning in order that it can be index parallel with motor areas of cortex. ll patients receive two PET-CT scanning, 1st at the end of neurology treatment, within1 month after stroke; 2nd in 6 weeks after the 1st PET-CT scanning. During the 6 weeks'time, rehabi-group receive integrative rehabilitation training while control group don't receive any training or guiding. Make use of simple finger movements (thumb taps quickly with other 4 fingers in turn) at each scanning to activate motor cortex. Considerating patients are in hemiparesis, ask them to carry out task, then analyze the relationship of best hand,unbest hand and dominant hemisphere. Patients have no food and water before examination, inject contrast agents 18F-FDG according to their blood glucose and weight, then ask them to close eyes in horizontal position, nextly perform test task for 5minutes in 15-20minutes'time, lastly stop movement until image collection. Get brain imaging in 3D mode, scanning time is 10 minutes, 5mm in thickness, obtain horizontal,coronal andsagittal imaging from OM line, collect 35 pictures, 5seconds each.Sketch region of interest (ROI) in each image level, whose location is determined by visual method,motor function orientation and PET-CT 3D image. According to distribution of motor regions, sketch precentral gyrus,postcentral gyrus in 12th level, front of paracentral lobule in 5th level, superior parietal lobule in 6th level, cingulate gyrus in 11th level, thalamus,caudate nucleusin 17th level, superior temporal gyrus in 20th level, cerebellum in 27th level, where locate 1cm3 square ROI of pixel, then get average counting of radioactivity in each pixel dimension of all motor regions.Analyze obtained data in t-test,X2-test and Spearman correlation analysis using SPSS10.0 statistics software. Result: 18F-FDG metabolism figure of affected and unaffected hemisphere after PET-CT scanning:there was significant difference in metabolism figure of affected hemisphere and unaffected hemisphere in all patients after 1st scanning (P<0.01); there was significant difference in metabolism figure ofunaffected hemisphere between 1st and 2nd PET-CT scanning in rehabi-group (P<0.05); there was significant difference in metabolism figure of affected hemisphere between 1st and 2nd PET-CT scanning in rehabi-group (P<0.01); there was no significant difference in metabolism figure of affected or unaffected hemisphere between 1st and 2nd PET-CT scanning in control group (P>0.05). here was significant difference between affected hemisphere and unaffected hemisphere in rehabi-group after 2nd PET-CT scanning, also between rehabi-group and control group in affected hemisphere after 2nd PET-CT scanning (P<0.01); there was no significant difference between affected hemisphere and uaffected hemisphere in control group after 2nd PET-CT scanning, also between rehabi-group and control group in unaffected hemisphere after 2nd PET-CT scanning (P>0.05). Changes of cortex activation: between affected hemisphere and unaffected hemisphere in rehabi-group after 1st PET-CT scanning there was significant difference in primary motor cortex (M1),primary premotor cortex (PPC),cerebellum (P<0.01), apparent difference in SMA (P<0.05) and no difference in SMC,PMC (P>0.05); Between 1st and 2nd PET-CT scanning in unaffected hemisphere in rehabi-group there was significant difference in M1,SMA,SMC,PPC,PMC (P<0.01), apparent difference in cerebellum (P<0.05); between affected hemisphere and unaffected hemisphere in rehabi-group after 2nd PET-CT scanning, there was significant difference in M1,SMA,SMC,PPC,cerebellum (P<0.01), apparent difference in PMC (P<0.05); there was no apparent difference in all function regions (P>0.05); between affected hemisphere and unaffected hemisphere in rehabi-group after 2nd PET-CT scanning, there was apparent difference in M1 (P<0.05), significant difference in SMA,SMC,PPC,cerebellum (P<0.01), no difference in PMC (P>0.05); Between rehabi-group and control group in unaffected hemisphere after 2nd PET-CT scanning,there was apparent difference in all function regions (P<0.05); between rehabi-group and control group in affected hemisphere after 2nd PET-CT scanning,there was apparent difference in all function regions (P<0.05) except M1 (P>0.05); between affected and unaffected hemisphere in control group after 1st PET-CT scanning:there was significant difference in MI,PPC,cerebellum (P<0.01), apparent difference in SMA (P<0.05), no difference in SMC,PMC (P>0.05); between 1st and 2nd PET-CT scanning in unaffected hemisphere in control group, there was no apparent difference in all fanction regions (P>0.05); between 1st and 2nd PET-CT scanning in affected hemisphere in control group, there was significant difference in M1 (P<0.01) and apparent difference in the other fanction regions (P>0.05); between affected and unaffected hemisphere in control group after 2nd PET-CT scanning: there was apparent difference in all function regions (P<0.05). Changes of Fugel-meyer assessment,Bather index (rectified),lesion of brain function: there was significant difference between 1st and 2nd comparison in rehabi-group (p<0.01); there was no apparent difference between 1st and 2nd comparison in control group (P>0.05); there was no apparent difference between rehabi-group and control group in 1st comparison (P>0.05); there was significant difference between rehabi-group and control group in 2nd comparison (P<0.05). Analyse 18F-FDG SUV value increased with Fugel-meyer assessment,Bather index (rectified),lesion of brain function in rehabi-group through Spearman correlation analysis: 18F-FDG SUV value increased was mild positive correlated with Fugel-meyer score, there was significant difference (r=0, P<0.01); was moderate positive correlated with Bather index, there was significant difference (r=0.461, P<0.01); was highly positive correlated, there was significant difference (r=7.20, P<0.01).Conclusion: when stroke patients enter chronic period, contralateralM1,bilateral SMA and SMC,ipsilateral cerebellum act more than in acute period whether they exercise or not, and rahabi-group metabolize more 18F-FDG than control group; superior parietal lobule,cingulate gyrus,thalamus,caudate nucleus,superior temporal gyrus metabolize more actively in both groups, that means motor program had reorganized after stroke. Rehabilitation training not only increases additional functions of regions above ,but activates lesion M1 and enhances its sensory and movement ability; patients who received rehabilitation training metabolize mainly in bilateral SMA and SMC,ipsicerebellum, bilateralM1,ipsilatareal PPC and PMC also metabolize in some extent, the affected hemisphere metabolizes more actively than unaffected hemisphere,from which we can infer affected hemisphere plays dominant role in chronic period, especially in SMC,SMA,while PPC,PMC mainly regulate movement; Analyze the relationship of 18F-FDG metabolism of all function regions in cortex and effectiveness of rehabilitation : after stroke motor conducting track was interrupted, though M1 has recovered in some extent, it was peri-lesion and secondary tissue that take charge of dominant role such fine function which was obtained through quantities of relearning and training, that has been tested from the relativity of 18F-FDG metabolism and clinical assessment including Fugel-meyer assessment,Bather index (rectified),lesion of brain function. |
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