| The purpose: This study applys diffusion tensor imaging (DTI) to prospectively observe the dynamics development process of pyramidal tract fiber proliferative remodeling after internal capsule infarction, measuring two DTI parameters of fractional anisotropy (FA) and mean diffusivity (MD) in infarct peripheral region, contralateral internal capsule, bilateral corona radiata area,bilateral centrum semiovale area, analysis the relationship between the changes of these parameters and neurological recovery, explore the function and significance of pyramidal tract fiber proliferative remodeling after internal capsule infarction during the process of patients neurological recovery.Methods: 15 cases of the age between 18-65, the initial onset of stroke,within 7 days of the onset, NIHSS score between 7-22, unilateral internal capsule infarction patients were selected as experimental group, while 15 cases of sex and age matched healthy volunteers were selected as control group.Experimental group of patients carried on DTI detection respectively in the first week (W1), the first month (Ml), the third month (M3 ) .The control group done the same DTI detection during the same time interval. Measuring two DTI parameters of fractional anisotropy (FA) and mean diffusivity (MD) in infarct peripheral region, contralateral internal capsule, bilateral corona radiata area,bilateral centrum semiovale area.The National Institute of health stroke Scale(NIHSS), the simple Fugl-Meyer motor function score (FM) and the Barthel index(BI) were used to evaluate the patients before each DTI detection.Respectively assess the degree of neurological deficits, the degree of motor dysfunction, the ability of daily living.The modified Rankin scale (mRS)were used to evaluate the stroke prognosis. In order to analyze the relationship between DTI parameters changes and nerve function recovery in the observation period, the formula | M3-W1 |/W1×100% were calculated for each part of the DTI parameters change percent and the nerve function scores change percent,two groups of the change percent were correlation analysised, P < 0.05 with statistical significance.Results:(1) During the observation period, the first week (W1), the first month (M1),the third month (M3) of patients with NIHSS score (12.07±1.75 VS 7.13±1.19 VS 3.47 ±1.41) gradually reduced, FM score (43.93 ±6.55 VS 71.00 ± 4.12 VS 86.40 ±3.04) and BI score (46.00 ± 6.33 VS 67.00 ± 5.28 VS 83.33±5.56) gradually increased. (2)The first week (W1),the first month (M1),the third month (M3) of patients with FA values of infarct peripheral region(0.58±0.02 VS 0.61±0.01 VS 0.67±0.01 )compared with the control group with FA values( 0.58±0.02 VS 0.58±0.02 VS 0.57±0.02 ),FA values of M1 and M3 all increased. The first week (W1), the first month (M1), the third month (M3) of patients with FA values of ipsilateral corona radiata area (0.47±0.02 VS 0.49±0.02 VS 0.52±0.01) compared with the control group with FA values(0.48±0.01 VS 0.47±0.01 VS 0.48±0.02),FA values of M1 and M3 all increased.The first week (W1), the first month (M1), the third month (M3) of patients with FA values of ipsilateral centrum semiovale area (0.38±0.02 VS 0.39±0.02 VS 0.43±0.01) compared with the control group with FA values(0.38±0.02 VS 0.37±0.01 VS 0.38±0.02),FA values of M1 and M3 all increased. The first week (W1),the first month (M1), the third month (M3) of patients with MD values (×10-3) of infarct peripheral region (0.641±0.10 VS 0.66±0.05 VS 0.68±0.05), MD values (×10-3) of ipsilateral corona radiata area(0.68±0.05 VS 0.66±0.05 VS 0.67±0.04),MD values (×10-3) of ipsilateral centrum semiovale area ( 0.73±0.04 VS 0.72±0.04 VS 0.72±0.03) were not statistically significant different at each time point. The MD values of each part of the experimental group compare with the corresponding parts of the control group had no statistical significance. (3) The first week (W1), the first month(M1), the third month (M3) of patients with FA values of contralateral internal capsule (0.58±0.02 VS 0.62±0.02 VS 0.66±0.01) compared with the control group with FA values (0.59±0.02 VS 0.58±0.02 VS 0.59±0.03),FA values of M1 and M3 all increased.The first week (W1), the first month (M1), the third month (M3) of patients with FA values of contralateral corona radiata area(0.48±0.02 VS 0.52±0.02 VS 0.54±0.01 )compared with the control group with FA values(0.48±0.01 VS 0.47±0.01 VS 0.48±0.02), FA values of M1 and M3 all increased.The first week (W1), the first month (M1), the third month (M3) of patients with FA values of contralateral centrum semiovale area (0.38±0.01 VS 0.41±0.01 VS 0.43±0.01) compared with the control group with FA values(0.38±0.02 VS 0.37±0.01 VS 0.38±0.02),FA values of M1 and M3 all increased. The first week (W1), the first month (M1), the third month (M3) of patients with MD values (×10-3) of contralateral internal capsule (0.63±0.06 VS 0.64±0.04 VS 0.64±0.06), MD values(×10-1)of contralateral corona radiata area(0.67±0.05 VS 0.65±0.04 VS 0.66±0.05), MD values (×10-3) of contralateral centrum semiovale area (0.70±0.04 VS 0.70±0.05 VS 0.70±0.04) were not statistically significant different at each time point. The MD value of each part of the experimental group compare with the corresponding parts of the control group had no statistical significance. (4) During the observation period, the FA values changes of infarct peripheral region, contralateral internal capsule,bilateral corona radiata area, bilateral centrum semiovale area and the NIHSS score changes were negatively correlated (P <0.05), while the FA values changes of these areas were positively correlated with the FM score changes and the BI score changes (P <0.05).Conclusion:The pyramidal tract fiber proliferative remodeling phenomenon appeared in the infarct peripheral region, contralateral internal capsule, bilateral corona radiata area, bilateral centrum semiovale area after internal capsule infarction.There was a positive correlation between the proliferative remodeling of pyramidal tract fibers and the recovery of nerve function in patients.It prompts that the pyramidal tract fiber proliferative remodeling after stroke promotes the neurological recovery of patients. |
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