捻转和非捻转刺激太溪穴后脑激活状态的功能磁共振成像研究

目的：观察功能磁共振成像了解捻转刺激太溪穴和非捻转刺激所引起的脑激活区状态。 方法：纳入健康青年志愿者12名,选取右侧太溪穴,采用组块刺激模式,静息阶段与刺激阶段交替出现,重复3次,分为3个组块。刺激为手法捻转行针或非捻转,非捻转即手放在针柄,但不进行任何操作。扫描后图像使用SPM2进行后处理。 结果：捻转刺激太溪穴主要激活了右侧颞上回BA22,左侧的额中回BA46,其次为左右顶叶的中央后回BA2,BA3,左额叶的额下回BA45和左顶叶的顶下小叶BA40;而非捻转刺激则没有激活。 结论：捻转刺激太溪穴和非捻转刺激的激活不同,与本经相关的经络、脏腑联系密切相关。     

fMRI及DTI技术在成人工作记忆研究的初步探索

目的：联合应用脑功能磁共振成像（BOLD—fMRI）和弥散张量成像（DTI）两种磁共振技术,探索工作记忆功能激活部位与叶间白质纤维束的关系。方法：健康志愿者16名,以步进式视觉累加试验作为刺激模式,扫描获得fMRI激活图及各向异性（FA）图。将两者叠加,选取双侧额顶叶白质兴趣区测量其部分FA值。结果：①额顶叶皮质为工作记忆功能最主要的激活区;②脑的激活像素几乎均位于FA程度低的区域（P〈0．01）;③左额顶间白质FA值较对侧高（P〈0．02）。结论：联合应用fMRI和DTI技术提示成人工作记忆功能与额顶叶白质纤维髓鞘化程度密切相关。     

功能性磁共振成像与针刺研究的基线选择

背景：功能性磁共振成像是近年发展起来研究穴位特异性的重要武器。目前大多数的针刺的功能性磁共振成像研究仍采用组块设计,而且绝大多数的都是在入针之后进行功能像扫描,认为入针后的静息段为纯静息,做为基线对照。但这与传统的针灸理论相冲突,因为传统针灸认为入针后也会出现入针效应。 目的：探讨如何选择针刺的功能性磁共振成像研究的基线。 方法：采用Hui的多组块设计,对入针后的效应进行相关分析,观察入针后是否有脑功能激活。 结果与结论：触觉刺激在刺激完成后,静息阶段不存在明显的脑功能变化;而针刺的入针时会产生一定的脑功能变化,入针后的静息段并非纯静息段。入针后的静息段也许不适于作基线。     

急性脊髓损伤的循证治疗

目的：对1例急性脊髓损伤患者进行循证治疗,总结评价治疗急性脊髓损伤的最佳证据。 方法：系统检索美国国家指南交换中心NGC（2000/2011）、Cochrane 图书馆（2011 年第1 期）、TRIP Database(2000/2011)、PubMed（1966/2011）中治疗急性脊髓损伤的相关研究,依据循证医学倡导的最佳研究证据、医师的临床经验和患者的意愿相结合制定治疗方案。 结果：共纳入34篇研究文献,包括1篇临床指南,22篇系统评价和11篇随机对照试验。目前的证据表明：对于急性脊髓损伤的患者,不推荐使用任何神经保护类药物;推荐早期手术;使用物理方式和注射低分子量肝素来防止静脉血栓的发生;功能性电刺激和针灸对急性脊髓损伤患者的功能恢复有促进作用。实验中未给予患者任何神经保护类药物,于伤后6h进行颈椎手术,术后应用低分子量肝素和物理措施预防血栓形成,每日进行呼肌功能锻炼,同时给予功能性电刺激和针灸治疗。经过3个月的随访,证实此方案适合该患者。 结论：应用循证医学的方法为急性脊髓损伤的患者制定个性化治疗方案,能显著提高治疗效果和预后。     

磁共振成像表现脊髓病变的脊髓亚急性联合变性病10例影像学特点

目的 探讨脊髓亚急性联合变性病(subacute combined degeneration of the spinal cord,SCD) 的临床,尤其是脊髓磁共振成像特点.方法 从2008 年11 月至2011 年4 月在四川大学华西医院诊断为脊髓亚急性联合变性的住院患者中筛选出磁共振成像表现有脊髓病变的患者进行回顾性研究.结果 90 例SCD 住院患者中有10 例磁共振成像显示脊髓病变,其中脊髓后份出现线条状、长条状、片条状或斑片状T2加权成像高信号病灶8 例,平均受累脊髓节段(5.71 ± 2.75)个,7 例病灶局限在颈1 ～胸8 脊髓范围.10 例患者中磁共振成像显示脑干后份、颈1 ～颈5 双侧脊髓侧索、颈7 ～胸7 脊髓中央区T2加权成像高信号影各1 例,脊髓萎缩1例;所有脊髓及脑干病灶均未见钆对比剂强化.结论 颈胸椎磁共振成像发现SCD 脊髓病变阳性率低,主要表现为颈1 ～胸8 脊髓后份超过3 个脊髓节段的条状T2加权成像高信号.     

血氧水平依赖功能磁共振成像对单指被动运动任务激活脑区分布的评价

背景：运动功能在脑皮质的功能映射是至今为止被研究得最多的课题之一,但既往对运动功能的绝大部分研究均采用主动运动任务,因而不可避免主动运动所带来的各种误差以及研究对象的局限性。被动运动显然可以解决以上困难以及误差,但是否可代替主动运动进行功能成像,现尚未有定论。 目的：通过比较右手食指主动与被动运动所激活脑区分布的差异,探讨以被动运动代替主动运动进行血氧水平依赖功能磁共振成像的可行性。 方法：分别采用被动及主动运动任务对8名健康志愿者进行血氧水平依赖功能磁共振成像。功能资料经过转换格式后,运用脑功能分析软件SPM2进行离线分析。通过比较健康受试者被动运动与主动运动的个体脑激活区、组内平均激活区的异同点,并对功能资料进行基于体素的组内、组间比较,验证以被动运动任务代替主动运动任务的可行性。另根据SPM2输出的时间－信号强度动态曲线,计算信号上升百分率,分析主、被动运动任务所引起的脑区激活程度的差异。 结果与结论：食指被动运动与主动运动比较,对侧大脑半球主要感觉运动区的激活区出现率均为100%,主、被动任务主要感觉运动区的激活区体积差异无显著性意义,辅助运动区、运动前区的出现率相近;被动运动与运动各活化区的激活曲线比较,两组资料间信号上升百分率的差异无显著性意义。提示被动运动可代替主动运动进行血氧水平依赖功能磁共振成像。     

中药薏苡仁和100Hz电针干预脊髓半横断性大鼠可降低损伤后胶质纤维酸性蛋白表达

实验建立正常对照组、假手术组、高低频电针组和中药薏苡仁干预组,横断T10左半侧的脊髓损伤模型大鼠,4h后使用5,100Hz电针刺激环跳(GB30)、足三里(ST 36)、至阳(DU9)及悬枢(DU5)或腹腔注射0.4μL中药薏苡仁粗提液(与生药比例为1:1),连续8周,观察发现低高频电针刺激及薏苡仁治疗能改善脊髓组织损伤区域形态,促进运动诱发电位的恢复,抑制损伤区胶质纤维酸性蛋白表达,改善半横断性脊髓损伤大鼠运动功能,以100Hz电针刺激和薏苡仁干预效果明显。     

多种脊髓诱发电位测评高龄脊髓型颈椎病患者颈脊髓机能

目的调查高龄脊髓型颈椎病患者的颈脊髓机能状态,并结合磁共振影像学（MRI）及X线放射学探讨其病理生理形成机制.方法对23例MRI显示为多椎间脊髓压迫的高龄脊髓型颈椎病患者,采用经颅电刺激-脊髓硬膜外记录、经脊髓硬膜外刺激-脊髓硬膜外记录、经正中神经刺激-脊髓硬膜外记录的三种脊髓诱发电位进行颈脊髓机能测定.结果17例患者（73.9%）显示为颈脊髓单一椎间的障碍,其中10例位于C3-4、5例位于C4-5、2例位于C5-6.另外6例患者（26.1%）的正中神经刺激-脊髓硬膜外记录结果表现为多个或两个椎间的障碍.结论在MRI影像学上显示为多椎间脊髓压迫的高龄脊髓型颈椎病患者,其多数在脊髓电生理上：表现为单一颈椎椎间的脊髓白质损伤,特征是不仅脊髓后索的感觉传导束,而且侧索的皮质脊髓束也受到损伤.结合X线放射学结果分析,C3-4或C4-5颈椎椎间的过大活动度或不稳是导致高龄脊髓型颈椎病患者脊髓传导束损伤的一个重要原因.     

正常人听觉皮层BOLD-fMRI的研究

目的 利用血氧水平依赖(blood oxygenation level dependent, BOLD)功能磁共振成像(functional magnetic resonance imaging, fMRI)(BOLD-fMRI)技术观察纯音刺激时正常人大脑两半球听觉皮层激活情况,对激活体积和信号强度进行定量分析,比较其差异.方法 15例健康志愿者行听觉刺激BOLD-fMRI检查.刺激声音为声强90dB、频率l000Hz的正弦波纯音脉冲.采用梯度回波平面成像(gradient echo planar imaging,GRE-EPI),快速采集全脑影像.所有数据均经统计参数图(statistical parametric mapping2,SPM2)软件离线后处理,获得听觉功能的解剖功能图、激活体积和信号强度.结果 15例健康志愿者纯音刺激时颞叶区均出现激活,颞上回激活率最高,其次为颞中回、颞横回.刺激单耳时对侧听觉皮层激活体积和信号强度明显大于同侧(P＜0.01).结论 正常人纯音刺激单耳时一般都有双侧听觉皮层激活,对侧听觉皮层激活体积和信号强度明显大于同侧,表现为对侧半球传导优势.     

脑功能磁共振成像技术对脑神经功能损伤诊断的价值

目的探讨脑功能磁共振成像及其处理分析技术对脑神经功能损伤诊断的价值。方法选择2013-06-2015-02入住我院接受治疗的18例神经外科脑损伤患者进行研究。保守治疗16例,手术治疗2例。对患者实施电针刺激功能磁共振成像(fMRI),分析得出静息状态信号(R)和刺激状态(A)的脑功能对比图。计算出每次刺激侧对侧的脑激活簇偏侧指数LI,并同时对相应的神经功能缺损状况进行评分。所有患者康复治疗时,除对症治疗外,还需接受按摩、高压氧、功能锻炼等康复措施。结果 14例患者做前后两期检查,取得两期的完整资料;4例患者仅做了1期检查,获得1期资料。18例患者共获得50次功能磁共振成像图像,剔除伪影较多的图像,最终选择符合条件的33次图像进行研究。33次成像图像显示,血氧水平依赖性增强(BOLD)均获得清晰的激活簇,且前后两期的LI变化值均有不同程度的提高,28次LI值为正值,5次LI值为负值,正值率为84.85%(28/33),但前后两期的LI变化值比较差异无统计学意义(P0.05)。前后两期的LI的改变值△LI以及相应的神经缺损评分△S为正值,且△LI与△S呈现正相关(P0.001)。结论通过电针刺激的脑功能磁共振成像能动态监测到患者脑激活簇的变化,并经数据处理分析后对脑神经功能损伤程度的诊断具有一定的判定价值。     

不同穴位皮部浅刺与常规针刺在fMRI脑功能成像中的差异

Few studies have examined the effects of different stimuli at a single acupoint using functional magnetic resonance imaging.The present study applied acupuncture at the Neiguan(PC 6),Waiguan(SJ 5),Zhigou(SJ 6) and Yanglingquan(GB 34) acupoints in healthy volunteers.fMRI was used to examine the activation of brain areas in response to different types of acupuncture(cutaneous or routine acupuncture) at each acupoint.There were no significant differences in the distribution of activation in the regions of interest between cutaneous and routine acupuncture at the Neiguan,Waiguan,and Zhigou acupoints,but some differences were observed between the two methods of acupuncture at the Yanglingquan acupoint.There were no significant differences in the intensity of induced activation between cutaneous and routine acupuncture at the Neiguan,Zhigou and Yanglingquan acupoints,but the activation intensity in the right cerebellum induced by routine acupuncture at the Waiguan acupoint was greater than that induced by cutaneous acupuncture.Results confirmed that cutaneous and routine acupuncture at the Neiguan,Waiguan,Zhigou and Yanglingquan acupoints activated different functional brain areas,and caused activation of different intensities in some areas.     

Reorganization of sensory processing below the level of spinal cord injury as revealed by fMRI

The adult mammalian CNS undergoes plastic changes in response to injury. To investigate such changes in spinal cord, functional magnetic resonance imaging (fMRI) was applied in rats subjected to complete transection of the mid-thoracic spinal cord. Blood oxygenation level-dependent (BOLD) contrasts were recorded in the distal spinal cord different times after injury (3, 7, and 14 days, and 1, 3, and 6 months) in response to electrical hind limb stimulation. Functional MRI demonstrated a substantial increase of neuronal activation in the ipsilateral dorsal horn after injury. Notably, 0.5 mA, which did not evoke activation in the normal spinal cord and was considered a non-painful stimulus, induced significant BOLD responses in the dorsal horn after injury. Increased sensitivity was also seen in response to 1.0 mA stimulation. Our results suggest exaggerated responsiveness of spinal neurons after spinal cord injury. Reorganization in the injured spinal cord has been shown to involve the amplification of peripheral inputs and implicated as one underlying mechanism causing neuropathic pain and autonomic dysreflexia. Since BOLD signals can demonstrate such plastic changes in spinal cord parenchyma, we propose fMRI as a method to monitor functional reorganization in the spinal cord after injury. Combining brain and spinal cord fMRI allows the visualization of neuronal activities along the entire neuroaxis and thereby an evaluation of the different plastic responses to CNS injuries that occur in the brain and the spinal cord.     

电刺激联合神经节苷脂治疗男性脊髓损伤后排尿障碍

目的探讨经皮穴位电刺激联合神经节苷脂穴位注射治疗男性脊髓损伤后排尿障碍的疗效。方法对48例脊髓损伤后出现功能性排尿障碍的男性患者,应用经皮穴位电刺激联合神经节苷脂穴位注射,并配合Crede手法挤压腹部下方促进排出尿液或间歇导尿,运用测定残留尿方法、膀胱容量的改变、肾功能的改变以及相关B超等指标评估治疗效果。结果 48例患者经治疗后,自行或配合Crede手法后,均能顺利排出尿液,尿残留量出现明显下降的趋势。经最长24个月的随访,48例患者均未出现尿路感染症状且肾功能均正常。结论经皮穴位电刺激+神经节苷脂穴位注射治疗男性脊髓损伤后神经源性功能性膀胱排尿障碍的疗效肯定,患者生活质量明显提高。     

Cortical processing of residual ano-rectal sensation in patients with spinal cord injury: an fMRI study

Abstract  Eleven paraplegic patients with complete traumatic spinal cord injuries (SCI) [according to American Spinal Injury Association (ASIA) criteria] at different levels (Th3–L3) were investigated during non-painful stimulation of the distal rectum and anal canal, using event related functional magnetic resonance imaging. Although a complete lesion was clinically diagnosed in all, four of them experienced reproducible sensations during anal and/or rectal stimulation. In six patients, individual data analysis revealed significant activation in the right secondary somatosensory cortex SII, the posterior cingular gyrus, the prefrontal cortex, and the left posterior cerebellar lobe during either anal or rectal stimulation or both. A Region of interest analysis using a data mask from healthy controls confirmed that SCI patients demonstrate cortical activation in areas similar to those activated in healthy volunteers, but to a less extensive degree. This supports the notion that the diagnosis of complete spinal cord transsection by ASIA criteria alone may be insufficient for assessment of 'completeness' of cord lesions, and that visceral sensitivity testing may be required in addition.     

Brain activation and inhibition after acupuncture at Taichong and Taixi: resting-state functional magnetic resonance imaging

Acupuncture can induce changes in the brain. However, the majority of studies to date have focused on a single acupoint at a time. In the present study, we observed activity changes in the brains of healthy volunteers before and after acupuncture at Taichong(LR3) and Taixi(KI3) using resting-state functional magnetic resonance imaging. Fifteen healthy volunteers underwent resting-state functional magnetic resonance imaging of the brain 15 minutes before acupuncture, then received acupuncture at Taichong and Taixi using the nail-pressing needle insertion method, after which the needle was retained in place for 30 minutes. Fifteen minutes after withdrawal of the needle, the volunteers underwent a further session of resting-state functional magnetic resonance imaging, which revealed that the amplitude of low-frequency fluctuation, a measure of spontaneous neuronal activity, increased mainly in the cerebral occipital lobe and middle occipital gyrus(Brodmann area 18/19), inferior occipital gyrus(Brodmann area 18) and cuneus(Brodmann area 18), but decreased mainly in the gyrus rectus of the frontal lobe(Brodmann area 11), inferior frontal gyrus(Brodmann area 44) and the center of the posterior lobe of the cerebellum. The present findings indicate that acupuncture at Taichong and Taixi specifically promote blood flow and activation in the brain areas related to vision, emotion and cognition, and inhibit brain areas related to emotion, attention, phonological and semantic processing, and memory.     

Magnetization transfer ratio of the spinal cord in multiple sclerosis: relationship to atrophy and neurologic disability.

The authors compare the spinal cord magnetization transfer ratio (MTR) of multiple sclerosis (MS) patients to healthy volunteers, relate MTR to spinal cord atrophy, and relate these and other magnetic resonance (MR) imaging parameters to disability. Sixty-five patients with MS (14 relapsing remitting [RR], 34 secondary progressive [SP], and 17 primary progressive [PP] MS), and 9 healthy volunteers were studied using MR at 1.0 T. Disability of the patients was assessed using the expanded disability status scale (EDSS). Magnetic resonance parameters were upper spinal cord MTR, number of focal spinal lesions, presence of diffuse abnormalities, and spinal cord cross-sectional area (CSA). Correlations were assessed using Spearman's rank correlation coefficient (r). Magnetization transfer ratio was higher in the controls (median, 33%; range, 30%-38%) than in patients with MS (median, 30%; range, 16-36; p < 0.05). In patients with MS EDSS correlated with spinal cord MTR, albeit weakly (r = -0.25, p < 0.05). Correlation between EDSS and spinal cord CSA was better (SRCC = -0.40, p < 0.01). No correlation was found between MTR and CSA (r = 0.1, p = 0.4). Combining MTR with spinal cord CSA improved correlation with EDSS (r = -0.46, p < 0.001), suggesting an independent correlation between disability and these 2 MR parameters. Expanded disability status scale scores were higher in patients who had diffuse spinal cord abnormality regardless of focal lesions (median, 6; range, 1.5-7.5) than in patients without diffuse abnormalities (median, 3.5; range, 0-8; p < 0.01). CSA was lower in patients with diffuse spinal cord abnormality (median, 62; range, 46-89 mm2) than in patients without diffuse abnormalities (median, 73; range, 47-89 mm2; p < 0.01). MTR was slightly lower in patients with diffuse spinal cord abnormalities (median, 29; range, 21%-33%) than in patients without diffuse abnormalities (median, 31; range, 16-36; t-test, p < 0.05).     

T1 hypointensity of the spinal cord in multiple sclerosis

It has recently been shown in multiple sclerosis (MS) that the volume of T1 hypointense lesions in the brain explains more of the variance in disability amongst patients than T2 lesion volume. T1 hypointense lesions may therefore represent areas of underlying pathology likely to be of functional significance, such as axonal loss. The spinal cord is a common area of involvement in MS and its dysfunction is likely to be responsible for much of the motor disability seen. Hence it serves as a useful model by which to examine the functional relevance of differing imaging sequences. We have therefore examined the relationship between T1 signal intensity in the spinal cord and disability in 60 patients with MS. We have also examined the relationship between T1 signal intensity and atrophy of the cord, as the latter is another potential marker of axonal loss. Sixty patients with MS underwent spinal cord imaging with a T1 weighted sequence to acquire axial sections of the cord at the C2 level. These sections were histogram matched to allow comparison of image intensity and a manual outlining technique was applied from which the mean cord intensity was calculated. Within the patient group there was a significant relationship between T1 signal intensity and disability as measured with the EDSS (r = −0.4, p < 0.005) and also between T1 signal intensity and atrophy (r = 0.36, p < 0.005). This study demonstrates that disability and atrophy are associated with a generalised reduction in cord signal on T1 weighted images. A lower T1 signal intensity in the spinal cord may be more pathologically specific than T2 hyperintensity and may represent underlying axonal loss, although gliosis and predominant white matter atrophy are alternative possibilities. Received: 7 April 2000, Received in revised form: 29 December 2000, Accepted: 10 January 2001     

Segmental hypersensitivity and spinothalamic function in spinal cord injury pain

The mechanisms underlying central pain following spinal cord injury (SCI) are unsettled. The purpose of the present study was to examine differences in spinothalamic tract function below injury level and evoked pain in incomplete SCI patients with neuropathic pain below injury level (central pain) versus those without such pain. A clinical examination, quantitative sensory testing and magnetic resonance imaging (MRI) were performed in 10 SCI patients with below-level pain and in 11 SCI patients without neuropathic pain. Patients with and without pain had similar reductions of mechanical and thermal detection thresholds below injury level. SCI patients with central pain had sensory hypersensitivity in dermatomes corresponding to the lesion level more frequently than SCI patients without pain, but this may in part be explained by the exclusion of at-level spontaneous pain in the pain-free group. The rostral-caudal extent of the lesion measured by MRI did not differ between the two patient groups, and there were no statistically significant differences in any of the predefined areas of interest on the axial plane images. This study suggests that neuronal hyperexcitability plays a key role in central SCI pain and furthermore - in contrast to previous findings - that loss of spinothalamic functions does not appear to be a predictor for central neuropathic pain in spinal cord injury.     

Increased S-nitrosothiols are associated with spinal cord injury in multiple sclerosis

Multiple sclerosis (MS) is an immune-mediated disorder associated with inflammation, demyelination and axonal damage. In search of potential biomarkers of spinal cord lesions in MS related to nitric oxide metabolites, we measured total nitrite and nitrate levels, and protein-bound nitrotyrosine and S-nitrosothiol concentrations in the serum of MS patients at different stages of the disease. Sixty-eight patients and 36 healthy volunteers were included in the study. Total nitrite and nitrate levels were augmented in relapsing-remitting MS, while increased S-nitrosothiol concentrations were found both in relapsing-remitting and secondary-progressive MS. Further analysis demonstrated that S-nitrosothiol levels were selectively increased in patients with spinal cord injury. The data suggest that high S-nitrosothiol concentration may be a potential serum biomarker for spinal cord injury in MS.     

The application of magnetic resonance in spinal cord disorders

The introduction of the proton magnetic resonance imaging into clinical practice shows significant diagnostic potentials, and throws a new light on pathological changes involving the spinal cord, in particular on those related to trauma and its sequelae. The initial experience concerning the use of the proton magnetic resonance imaging in 28 patients, in whom paraplegia or quadriplegia developed following an injury to the spine, indicates that magnetic resonance imaging has specific advantages over other investigative modalities. Magnetic resonance imaging techniques permit, in most instances, a distinct demarcation of the spinal cord in its entire length or in segments, without ionising radiation or intrathecal introduction of contrast media. A significant superiority of magnetic resonance imaging is the feasibility to apply multiplanar imaging of the spinal cord without moving the paralysed patient and the possibility to repeat the imaging, even on an outpatient basis, without a major discomfort to the patient. Most of the post-traumatic lesions can be identified in magnetic resonance images, however, the application of paramagnetic enhancers may have to be considered in order to achieve a distinct delineation of a lesion from the surrounding normal spinal cord tissue in selected cases. Despite some current limitations, magnetic resonance imaging has opened new avenues to obtain information about the anatomy, and, in particular, the biochemistry of the spinal cord.