| Objective: To investigate the variation of ADC value and FA value in different periods of brainstem infarction and to analyze the correlation between the variation of them and NIHSS score.Methods: A total of 71 patients with brainstem infarction,including 15 cases in acute stage,46 cases in subacute stage and 10 cases in chronic stage,were collected from the Department of Neurology,the First Affiliated Hospital of Wannan Medical College from January 2016 to November 2017.In addition,30 healthy volunteers(15 males and 15 females)were selected as the control group.Both the case group and the control group underwent conventional MRI and DTI scan.Before and after the scan,two senior neurologists scored each patient in the case group by NIHSS,and took the average of both as the final NIHSS score.In the post-processing software,the infarct focus was described manually and the maximum infarct area was displayed.The ADC value and FA value of the brain stem of the control group were measured at different levels,and the ADC value and FA value of the infarcted area and the corresponding area of the healthy side in the case group were measured.The r ADC and r FA were calculated,and the ADC map and the bilateral white matter fiber bundle map were reconstructed.T test of the mean of two independent samples was used to compare the ADC value of the diseased side and the contralateral side of the brainstem infarction,and the difference of ADC value,ADC value and r FA value of the diseased side between the three groups in the acute,subacute and chronic stages were compared by single factor analysis of variance(ANOVA).Spearman rank correlation analysis was used to analyze the correlation between the acute and subacute brainstem infarction area and the DTT classification and the NIHSS score,which was statistically significant based on p<0.05.Results: 1.There was no significant difference in ADC between the left and right sides of the brain stem in 30 healthy volunteers(p > 0.05).There was no significant difference in FA value between the left and right sides of the brain stem in 30 healthy volunteers(p > 0.05).2.15 cases in 71 cases of acute brainstem infarction cases,46 subacute cases,10 cases of chronic period;and the ratio between male and female 1.63:1;in 61 cases of pontine infarction(85.92%),3 cases of midbrain(4.23%),4 cases of medulla(5.63%),3 cases in the junction of pons and medulla(4.23%);in 34 cases of brain stem left,37 cases in the right brain stem,and the ratio between left and right is 0.92:1;15 cases were "cut" change(21.12%).3.The ADC value of the affected side in the patients with acute brainstem infarction(5.28±1.22)was significantly lower than that in the contralateral side(8.61±1.82),and the difference was statistically significant(t=-5.90,p<0.05).The ADC value of the affected side in the patients with subacute brainstem infarction(5.85±1.43)was lower than that in the contralateral side(8.28±1.73),and the difference was statistically significant(t=-7.36,p<0.05).The ADC value of the affected side in the patients with chronic brainstem infarction(12.27±3.00)was higher than that in the contralateral side(7.66±1.00),and the difference was statistically significant(t=4.60,p<0.05).4.The FA value of the affected side in patients with acute brainstem infarction(0.26±0.09)was lower than that in the contralateral side(0.43±0.10),and the difference was statistically significant(t=-4.70,p<0.05).The FA value of the affected side in the patients with subacute brainstem infarction(0.23±0.10)was lower than that in the contralateral side(0.41±0.13),and the difference was statistically significant(t=-7.25,p<0.05).The FA value of the affected side in the patients with chronic brainstem infarction(0.14±0.07)was lower than that in the contralateral side(0.47±0.13),and the difference was statistically significant(t=-7.16,p<0.05).5.The ADC values of the diseased side increased gradually in the three case groups.However,there was no significant difference in ADC between the subacute group(5.85±1.43)and the acute group(5.28±1.22),and the difference between the other two groups was statistically significant.The levels of r ADC in patients with acute brainstem infarction(0.61±0.13),subacute stage(0.71±0.12)and chronic stage(1.62±0.31)increased gradually,and the differences were statistically significant.6.The FA value of the diseased side decreased gradually in the three case groups.However,there was no significant difference in FA between the subacute group(0.23±0.10)and the acute group(0.26±0.09),and the difference between the other two groups was statistically significant.The r FA value decreased gradually in the three case groups.However,there was no significant difference in r FA between the subacute group(0.57±0.13)and the acute group(0.61±0.15),and the difference between the other two groups was statistically significant.7.There was no significant correlation between the area of brainstem infarction and NIHSS score in acute and subacute stage(p>0.05).There was no significant correlation between r ADC and NIHSS score in patients with subacute brainstem infarction(p>0.05),but there was a negative correlation between r FA score and NIHSS score in patients with acute brainstem infarction(r=-0.63,p<0.05),but no significant correlation between r FA score and NIHSS score in patients with subacute brainstem infarction(r=-0.08,p>0.05).8.The DTT classification of acute brainstem infarction was positively correlated with NIHSS score(r=0.76,p<0.05),and the DTT classification of subacute brainstem infarction was positively correlated with NIHSS score(r=0.74,p<0.05).Conclusion: 1.There is no significant difference in ADC value and FA between the right and left sides of the brain stem in healthy people.The cerebral stem infarction occur in the pontine,and is more common in one side.The "half cut sign of brain stem" is the characteristic MRI manifestation of brain stem infarction.2.In acute,subacute and chronic phases of brainstem infarction,the change of ADC value and r ADC decrease first and then increase gradually,but the r ADC value is more sensitive and objective to reflect the diffusion characteristics of different individuals.3.In the three case groups,the FA value of the diseased side and r FA value decrease gradually,and the smaller the r FA value,the higher the NIHSS score.Therefore,FA values(especially r FA)in brainstem tissues rich in fiber bundles are more sensitive in evaluating the relationship between brainstem infarction and clinic.4.DTT can visualize the relationship between the white matter fiber bundle and the lesion of cerebral stem infarction and the involvement of the fibrous bundle,and it is positively correlated with the clinical NIHSS score.It has a certain guiding effect on the clinical treatment of brainstem infarction patients in different period. |
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