Journal of the Korean Society of Radiology (한국방사선학회논문지)

The Korean Society of Radiology (한국방사선학회)
권호 표지
DOI QR코드

DOI QR Code

Fractional Anisotropy of Diffusion Tensor Imaging as a Predict Factor in Patient with Acute Cerebral Infarction

급성 뇌경색 환자에서 예후 추측인자로서의 확산텐서영상 비등방도

  • 김성길 (한려대학교 방사선학과) ;
  • 은성종 (한려대학교 방사선학과)
  • Received : 2010.04.26
  • Accepted : 2010.09.14
  • Published : 2010.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Diffusion tensor imaging(DTI) allows the visualization of fiber tract damage in patients with cerebral infarction. The purpose of this study is to evaluate the correlation between degree of NIH stoke scale and fractional anisotropy (FA) in patient with cerebral infarction. Material and Methods : 16 patients aged 36~77 years(male : 11, female : 5, mean age : 61y), diagnosed cerebral infarction by diffusion weighted imaging(DWI), underwent 24 directional diffusion tensor imaging(DTI). Patients had the DTI taken within 3days of stroke onset. Comparison of DWI, FA value on DTI were measured infarcted area and counter part of specific region of interest (ROI). And evaluation of differences between clinically improved patient group (n=9) and unimproved patient group (n=7) until 2 week follow up after development of cerebral infarction. Clinical status was scaled by NIH stroke scale. Results : Quantitative measurements of FA confirmed statistically the significant diffusion changes in the infarct compared with the matched-counter part region. In DWI, the infarcted area shows high signal intensity, however FA value on DTI was lower than normal brain parenchyma. The FA value of clinically improved patient by NIH stroke scale was 0.49, and the value of contralateral normal brain parenchyma was 0.41. On the contrary, FA value of infarcted area shows about 15% lower than normal brain parenchyma. But, the FA value of unimproved patient by NIH stroke scale represents a half those of contralateral normal brain parenchyma (0.28 on infarcted area vs. 0.56 on normal brain parenchyma). So, the FA value of unimproved patient group was considerably less than those of improved. Conclusion : It is concluded that the unimproved patient group after cerebral infarction showed much less FA value than that of normal brain parenchyma. The FA value of DTI may be one of the useful parameter to predict outcome of cerebral infarction patients.

확산 텐서 영상을 이용하여 뇌경색 환자의 손상된 백질 섬유를 시각화할 수 있게 되었다. 본 연구의 목적은 뇌경색 환자에서 NIHSS와 분할 비등방도의 상관을 평가하고자 하였다. MR 확산영상에서 뇌경색이 확인된 16명(남:11, 여:5, 평균연령 61세) 환자를 대상으로 24방향 DTI를 시행하였다. 뇌경색 발발 후 2주 이내에 증상이 개선된 환자 9명과 증세가 악화된 환자 7명으로 구분하였다. FA값의 정량측정을 위해 병소와 병소 반대측이 통계적으로 유의한 차이가 있음을 확인하였다. 확산강조영상에서는 병소가 고신호로 보였으나, FA값은 정상측 보다 낮게 측정되었다. NIHSS상의 임상증상이 개선된 환자들의 FA값은 0.41, 반대측 정상부는 0.49로 병소측이 15%정도 낮게 측정되었다. 그러나 NIHSS상 증상이 악화된 환자들의 경우 병소측 FA값이 0.28, 반대측 정상부는 0.56으로 큰 차이를 보였다. 결론적으로 DTI에서의 FA값은 뇌경색 환자의 예후를 평가하는데 매우 유용한 지표로 이용될 수 있을 것이다.

Keywords

References

  1. 오영택, 김동익, 정은기 등. Single Short EPI 기법을 이용한 뇌경색 환자의 확산 강조영상. 대한방사선의학회지 1998;39:7-13
  2. 최수정, 최충곤 김재균 등. 조기 허혈성 뇌경색: 확산강조영상과 현성확산계수영상의 비교. 대한방사선의학회지 1998;39:21-27
  3. Basser PJ, Pierpaoli C. Microstructural and physiological features of tissue elucidated quantitative-diffusion-tensor MRI. J Magn Reson 1993;111:209-219
  4. Chenevert TL, Burunberg JA, Pipe JG. Anisotropic diffusion within human white matter: demonstration with NMR techiques in vivo. Radiology 1990; 177:401-405
  5. Sung HJ, Sang HC, Diffusion anisotropy in the early stage of stroke can predict motor outcome. Restorative Neurology and Neuroscience 2005;23; 11-17
  6. David JW, Ahmed TT, Christopher AC. Diffusion tensor imaging can detect and quantify corticospinal tract degeneration after stroke. J Neurol Neurosurg Psychiatry 2000;69:269-272 https://doi.org/10.1136/jnnp.69.2.269
  7. 장서린, 유승, 오범진, 김원, 임경수. 급성뇌경색 환자의 생존퇴원 시 기능적 회복에 대한 초기 예측인자. 대한응급의학회지,2006; 17:5:438-445
  8. Le Bihan D, Mangin JF, Poupon C, Clark CA. Diffusion tensor imaging: concepts and application. J Magn Reson Imaging 2001;13:534-546 https://doi.org/10.1002/jmri.1076
  9. Pierpaoli C, Basser PJ, Toward a quantitative assessment of diffusion anisotropy. Magn Reson Med 1996;36:893-906 https://doi.org/10.1002/mrm.1910360612
  10. Weimar C, Konig IR, Krayweinkel K et al, Age and National Institutes of Health Stroke Scale Score within 6 Hours after onset are accurate predictors of outcome after cerebral ischemia: Development and external validation of prognostic models, Stroke 2004;35(1): 158-162
  11. Adams HP Jr, Davis PH, Leira EC. Chang KC, Bendixen BH, Clarke WR, et al. Baseline NIH Stroke Scale strongly predicts outcome after stroke: A report of the trail of Org 10172 in Acute Stroke Treatment(TOAST). Neurology 1999;53(1):126-131 https://doi.org/10.1212/WNL.53.1.126
  12. Mori S, Crain BJ, Chacko VP, van Zijl PC. Three-dimensional tracking of axonal projection in the brain by magnetic resonance imaging. Ann Neurol 1999;45:265-269 https://doi.org/10.1002/1531-8249(199902)45:2<265::AID-ANA21>3.0.CO;2-3
  13. Lyden P, Lu M, Jackson C, Marler J, Underlying structure of the National Institutes of Health Stroke Scale: results of a factor analysis. Stroke 1999; 30:2347-2354. https://doi.org/10.1161/01.STR.30.11.2347