Study On Acupuncture Improved Motor Dysfunction In Ischemic Stroke By Fractionalamplitude Of Low Frequency Fluctions And DTI

Objective: Blood Oxygenation Level Dependent functional Magnetic Resonance Imaging(BOLD-fMRI)and Diffusion tensor Imaging(DTI)were applied to study the changes of Fractional amplitude of low frequency fluctions and the FA value of the corticospinal tract in ischemic stroke patients with limb motor dysfunction treated by acupuncture,and to further explore the rehabilitation mechanism.It provides imaging basis for the wide application of acupuncture in stroke rehabilitation.Methods: We collected 33 ischemic stroke patients with right limbs motor dysfunction as patients group,whose lesion were located in basal ganglia or peripheral tissue.The patients were treated with acupuncture for4 weeks while receiving conventional stroke treatment.Brunnstrom stage and MRI,including the resting state functional magnetic resonance BOLD-fMRI and DTI examinations,were performed both before and after acupuncture treatment.The BOLD-fMRI and DTI examinations were performed on 30 healthy controls matched by age,sex and education.Calculate the fractional amplitude low-frequency fluctuation(fALFF)for every subjects,and conducted double-sample t-test to compare the fALFF values of patients before and after acupuncture treatment with healthy people respectively,to obtain the brain areas which fALFF values were different.The correlation analysis was made between fALFF ratio of related brain areas and brunnstrom stage after treatment.The DTI data were performed with probabilistic tractograghy,and the fractional anisotropy(FA)of the corticospinal tract(CST)was obtained.The paired sample t test was performed before and after acupuncture treatment,and the difference in FA value of CST before and after treatment was analyzed.Results:(1)Patients before acupuncture treatment compared with healthy subjects,fALFF values were significantly decreased in the right precuneus,bilateral posterior cingulate gyrus,left thalamus,right inferior parital lobule,bilateral precentral gyrus,and left paracentral gyrus(AlphaSim corrected,Clusters>30,P<0.01).fALFF values were significantly increased in the left cerebellum,left gyri rectus,right dorsolateral superior frontal gyrus,bilateral orbital frontal gyrus,bilateral medial superior frontal gyrus,and bilateral cuneus(AlphaSim corrected,Cluster>30,P<0.01).(2)Patients after acupuncture compared with healthy subjects,fALFF was significantly decreased in bilateral posterior cingulate gyrus and right inferior parital lobule.(AlphaSim,Clusters>30,P<0.01).fALFF valueswere significantly increased in brain stem,left inferior temporal gyrus,left cerebellum,left superior occipital gyrus,right cuneus,and left precentral gyrus.(3)fALFF ratio of left precentral gyrus before and after treatment was positively correlated with upper limb brunnstrom stage(r=0.854,P=0.000).fALFF ratio of left paracentral gyrus before and after treatment was positively correlated with lower brunnstrom stage(r=0.709,P=0.000).(4)The CST FA value of stroke patients without treatment was significantly lower than that of healthy people(P=0.000),indicating that the CST of stroke patients was damaged;the CST FA value of patients compared with before and after treatment was significantly higher,the difference was statistically significant(p=0.000),indicating that acupuncture treatment had therapeutic effect on the integrity of CST.Conclusion:(1)Campared with the healthy group,the fALFF values of the patient group before acupuncture treatment were decreased in the brain areas related with motor function,such as the bilateral precentral gyrus and the left paracentral lobule,and the FA values of CST decreased.It is suggested that the functional decline of motor-related brain regions and corticospinal tract injury may be the neural basis of limb motor dysfunction after cerebral infarction,which was showed by fALFF value and FA value decreasing.(2)The brunnstrom stages both in upper and lower limbs,the fALFF value in motor related brain regions,such as(precentral gyrus and paracentral gyrus),and the FA value of CST were all increased in patients after acupuncture treatment,shows that acupuncture treatment can enhance motor-related brain areas activity,promote restoration of the corticospinal tract.This may be the mechanism of acupuncture improved motor-related brain function and repaired brain structure,which promote motor function rehabilitation.(3)The fALFF ratio of ipsilateral precentral gyrus and paracentral gyrus befor and after acupuncture treatment may be an important biological marker for rehabilitation of limb motor dyfunction in patients with cerebral infarction.