الفهرس | Only 14 pages are availabe for public view |
Abstract Summary and Conclusion The DTI is a noninvasive magnetic resonance imaging (MRI) technique that is similar in physical idea and diagnostic criteria to the DWI, yet it provides more per voxel information that allows the white matter microstructural &the virtual reconstruction of the fiber tracts. Corticospinal tract reconstruction in the acute phase of stroke is a feasible technique that allows the direct visualization of the tract & its relationship to the volume of the infarction as well as the degree of involvement and the expected motor prognostic outcome. The aim of this study was to assess the role of diffusion tensor imaging fiber tractography in prediction of the degree of functional disabilities after acute cerebral lacunar infarctions. The present study was performed on thirty patients with acute Lacunar infarction (18 male and 12 female) admitted to the neurovascular unit and ICUs of the Neurology Department and The Center of Neurology and Psychiatry, Tanta University Hospitals with variable degrees of neurological manifestations in the period from 1st of November 2017 till the end of November 2018. Twenty age and sex matched healthy subjects were included in study as a control group. All patients underwent complete history taking, general and full neurological examination then conventional MRI Imaging followed by diffusion tensor imaging and tractography then the degree of patient’s dependence will be done 1 and 3 months post-stroke using the Modified Barthel Index (MBI), the cognitive assessment was done using The Montreal Summary and Conclusion 119 Cognitive Assessment Scale (MoCA) then we classified patients according to MBI into dependent group and independent group. The most frequent sites of infarctions were the temporal region (20%), posterior limb of the internal capsule (16%) and the brain stem (16%) with left cerebral hemisphere predominance (53.33%). We measure Fractional anisotropy, fiber number and mean diffusivity in ipsilateral and contralateral side, the FA values in affected areas were significantly increased (p-value 0.024) in comparison to the unaffected areas. We found NIHSS was significantly high in dependent group, while MOCA revealed significant decrease in cognition among dependent group when compare with independent and control groups. We found significant negative correlation between FA values and CST fiber numbers. Infarction volume range from 0.9mm3 to 4mm3 and significant negative correlation between MBI and volume of infarction. We found Significant positive correlation between the FA values and MBI (r = 0.307and p-value 0.037). Summary and Conclusion 120 In conclusion • Diffusion tensor imaging is a noninvasive magnetic resonance imaging technique which can visualize the changes in the integrity of the CST after cerebral small arteries infarctions which cannot be detected by conventional MRI. • Combining clinical scores with information about corticospinal tract (CST) integrity can improve predictions about motor outcome as the extent of CST damage on DTI and the overlap between the CST and a lesion are key prognostic factor that determines motor performance and outcome. • Accurate early prediction of recovery would help rationalize rehabilitation goals and improve the design of trials testing strategies to facilitate recovery. • The severity of motor impairments correlates with functional disability and quality of life. |