Application of DTI and DTT in the evaluation of prognosis in patients with acute middle cerebral artery infarction

Objective To investigate the correlation between different damage degrees of CST and prognosis in patients with acute middle cerebral artery infarction by using MR diffusion tensor imaging(DTI) and diffusion tensor tractography(DTT). Methods Twenty patients with middle cerebral artery infarction were prospectively examined with 1.5T diffusion tensor imaging and diffusion tensor tractography within a 72-hour mean interval onset. The fractional anisotropy(FA) and the apparent diffusion coefficient(ADC) in ischemic lesion and the oppsite area in nonaffected hemisphere, the fringe area of infarcts, cerebral peduncle were measured. According to the extent of CST destruction, the affacted CST was divided into three grades The twenty patients were graded by NIHSS and FMS. Spearman correlation analysis was applied to reveal the relationships between the extent of CST destruction and clinical prognosis. Results FA and ADC values notably decreased in infraction lesions verses non-affected hemisphere(P0.001), which revealed that the tissue in infarction lesions had been damaged in different extent. Negative correlation was found between the extent of CST destruction and motor dysfunction grading according to FMS(r=-0.843, P0.001), which revealed that the more serious CST was damaged, the lower motor dysfunction grading, the heavier degree of motor impairment, the worse prognosis. Positive correlation was found between the extent of CST destruction and recovery of neurological function according to NIHSS(r=0.819, P0.001), which revealed that the more serious CST was damaged, the lower neurological function score, the worse prognosis of neurological function. Conclusion DTI and DTT provide a way for the quantitative analysis of acute middle cerebral artery territory lesions and the degree of CST damage, and provide reliable basis for early accurately judge the clinical prognosis and guide clinical treatment.