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• 综述 •
扩散张量成像技术评估皮质脊髓束重塑在针灸促进中风后运动功能恢复机制中的研究进展
仲思潼 宁可星 陈涛 曹馨元 朱瑾怡 杨蕊 邱昕玥 王骁 杨成妍 孙忠人 尹洪娜

Cite this article as ZHONG S T, NING K X, CHEN T, et al. Advances in diffusion tensor imaging of corticospinal tract remodeling for motor recovery after stroke with acupuncture and moxibustion[J]. Chin J Magn Reson Imaging, 2026, 17(8): 130-138.本文引用格式 仲思潼, 宁可星, 陈涛, 等. 扩散张量成像技术评估皮质脊髓束重塑在针灸促进中风后运动功能恢复机制中的研究进展[J]. 磁共振成像, 2026, 17(8): 130-138. DOI:10.12015/issn.1674-8034.2026.08.014.


[摘要] 皮质脊髓束（corticospinal tract, CST）是中风后运动功能恢复的核心通路，扩散张量成像（diffusion tensor imaging, DTI）作为一种无创客观性技术，能通过相关影像参数客观量化CST的微观结构，目前已广泛应用于中风研究。基于DTI技术揭示针灸治疗中风后运动功能障碍（motor dysfunction after stroke, MDAS）的中枢作用机制，是当前针灸疗效研究领域的重点方向。本综述系统总结了CST的解剖结构与功能、DTI评估CST的技术原理、核心指标、影像学表现、纤维追踪方法以及针灸干预MDAS的DTI研究证据，并基于现有证据探讨针灸诱导运动功能恢复及神经重塑的可能机制，同时指出了当前研究存在的局限性及今后研究方向，以期为提高针灸治疗MDAS的疗效提供新思路。
[Abstract] The corticospinal tract (CST) is a core neural pathway for motor function recovery after stroke. Diffusion tensor imaging (DTI), as a non-invasive and objective technique, can quantitatively assess the microstructure of the CST through relevant imaging parameters and has been widely applied in stroke research. Unraveling the central mechanism of acupuncture and moxibustion in treating motor dysfunction after stroke (MDAS) based on DTI technology is a key focus in the current field of acupuncture efficacy research. This review systematically summarizes the anatomical structure and function of the CST, as well as the technical principles, core indicators, imaging features, and fiber tractography methods of DTI for CST evaluation, along with DTI-based evidence on acupuncture and moxibustion intervention for MDAS. Based on the available evidence, this review discusses the possible mechanisms by which acupuncture and moxibustion induce motor function recovery and neural remodeling, while pointing out the limitations of current studies and future research directions, with the aim of providing new insights into improving the efficacy of acupuncture and moxibustion in treating MDAS.
[关键词] 中风后运动功能障碍；皮质脊髓束；扩散张量成像；磁共振成像；针灸
[Keywords] motor dysfunction after stroke；corticospinal tract；diffusion tensor imaging；magnetic resonance imaging；acupuncture and moxibustion

仲思潼 1   宁可星 1   陈涛 1   曹馨元 1   朱瑾怡 1   杨蕊 2   邱昕玥 1   王骁 1   杨成妍 2   孙忠人 1   尹洪娜 1, 2*  

1 黑龙江中医药大学，哈尔滨　150040

2 黑龙江中医药大学附属第二医院针灸七科，哈尔滨　150001

通信作者：尹洪娜，E-mail: 18800462110@163.com

作者贡献声明：：尹洪娜设计本综述的方案，对论文重要内容进行了关键性修改；仲思潼起草和撰写稿件，获取、分析和解释本综述的文献；宁可星、陈涛、曹馨元、朱瑾怡、杨蕊、邱昕玥、王骁、杨成妍、孙忠人获取、分析或解释本综述的文献，对稿件重要内容进行了修改；尹洪娜获得了国家重点研发计划项目（编号：2022YFC3500403）的资助；孙忠人获得了国家重点研发计划项目（编号：2022YFC3500405）的资助；全体作者都同意发表最后的修改稿，同意对本综述的所有方面负责，确保本综述的准确性和诚信。


基金项目： 国家重点研发计划项目 2022YFC3500403，2022YFC3500405
收稿日期：2026-02-27
接受日期：2026-07-09
中图分类号：R445.2  R743.3 
文献标识码：A
DOI: 10.12015/issn.1674-8034.2026.08.014
本文引用格式 仲思潼, 宁可星, 陈涛, 等. 扩散张量成像技术评估皮质脊髓束重塑在针灸促进中风后运动功能恢复机制中的研究进展[J]. 磁共振成像, 2026, 17(8): 130-138. DOI:10.12015/issn.1674-8034.2026.08.014.

0 引言

       中风亦称脑卒中，临床以突发昏仆、一侧肢体麻木、半身不遂或口眼歪斜等为主要表现，具有发病急、病程长和后遗症多的特点[1, 2]。根据诱发因素，中风主要分为出血性中风和缺血性中风。中风是目前导致我国成人残疾、死亡的首位病因，而中风后运动功能障碍（motor dysfunction after stroke, MDAS）在临床上最为常见，目前已占所有中风病例的80%以上[3]。

       皮质脊髓束（corticospinal tract, CST）是中枢神经系统中控制自主运动的核心纤维通路[4, 5]。CST损伤后将直接影响人体的运动功能[6]，因此，能否修复或重塑CST已成为针灸治疗MDAS的重要评价标准。扩散张量成像（diffusion tensor imaging, DTI）能通过测量水分子扩散的各向异性，客观量化白质（white matter, WM）的微观结构[7, 8]，目前已作为评估CST结构的重要方法[9]，并应用于MDAS的研究中。

       针灸治疗MDAS的临床疗效已得到广泛认可，但其促进中风后运动功能恢复的中枢机制尚不明确——既往研究多停留于功能改善的主观量表评价，缺乏针灸重塑关键运动神经通路结构的直接证据。一项2023年发表的Meta分析指出，DTI技术在针灸临床研究中的应用尚不成熟，主要表现为临床普及度较低、分析过程与测量方法不一致、样本量估算不规范、研究样本量偏小、多中心研究不足、盲法与分配隐蔽不充分等[10]。目前，虽有综述涉及DTI在针灸治疗MDAS中的应用[10, 11]，但多侧重于临床疗效汇总，对DTI技术原理与CST评估方法的系统梳理不足，对针灸调控CST重塑的证据整合亦不全面，且忽视了DTI参数变化与运动功能改善之间的“解离”现象，亦未对现有证据进行系统质量评价[10, 11, 12, 13]。针对以上不足，本综述构建了从CST的解剖结构、DTI技术原理与核心指标[各向异性分数（fractional anisotropy, FA）/平均扩散系数（mean diffusivity, MD）/径向扩散系数（radial diffusivity, RD）/轴向扩散系数（axial diffusivity, AD）]、纤维追踪方法到针灸干预MDAS的完整论述框架。在此框架下，探讨DTI-功能“解离”现象及其可能机制，并按牛津循证医学中心标准对纳入文献进行证据等级评价。需说明的是，本文中“针灸”为针刺和灸法的统称，但现有DTI证据大多数来自针刺研究，灸法独立效应的证据极为有限，故本文梳理的文献证据以针刺相关研究为主，灸法的特异性效应有待后续专项验证。

       综上，本文系统总结了DTI技术评估CST在针灸治疗MDAS中的应用进展，从影像学层面归纳针灸促中枢重塑的效应机制，呈现现有证据并指出不足，以期为针灸精准治疗MDAS的临床决策和机制研究提供影像学参考依据。

1 文献检索方法

       为系统回顾DTI技术评估CST重塑在针灸治疗MDAS中的应用研究进展，本文遵循综述性研究的常用方法进行文献检索。检索数据库包括PubMed、Web of Science、中国知网（CNKI）和万方数据知识服务平台。检索时间范围为各数据库建库至2026年07月。英文检索式为：（“diffusion tensor imaging” OR “DTI” OR “diffusion-weighted imaging”） AND （“corticospinal tract” OR “CST” OR “pyramidal tract” OR “white matter” OR “wallerian degeneration”） AND （“stroke” OR “cerebral infarction” OR “cerebral hemorrhage” OR “ischemic stroke”） AND （“motor function” OR “motor recovery” OR “motor dysfunction” OR “motor impairment” OR “hemiplegia”）；中文检索式为：（“弥散张量成像” OR “扩散张量成像” OR “DTI”）AND（“皮质脊髓束” OR “CST” OR “白质” OR “华勒氏变性”）AND（“脑卒中” OR “中风” OR “脑梗死” OR “脑出血”）AND（“运动功能” OR “运动障碍” OR “偏瘫”），采用主题词与自由词相结合的方式进行文献检索。文献纳入标准：（1）研究对象为脑卒中患者，明确诊断为伴运动功能障碍；（2）采用DTI技术或多种神经影像技术作为研究工具或疗效评价手段；（3）研究类型涵盖观察性研究（横断面、纵向、病例对照）、干预性研究、系统综述、Meta分析，以及设计较为规范的高质量学位论文，优先纳入发表于同行评审期刊的文献，学位论文则根据其研究设计酌情纳入。排除标准：（1）重复发表、无法获取全文或数据不完整的文献；（2）研究内容与CST的解剖结构与功能、DTI评估CST的技术原理、核心指标、纤维追踪方法、针灸干预MDAS的DTI研究证据等主题无关的文献。按上述流程筛选后，最终纳入符合标准的文献共计114篇。

2 CST的解剖结构与功能

       CST是负责肢体运动功能的重要白质纤维束[14]，其纤维主要起源于初级运动皮层（primary motor cortex, M1）、辅助运动区（supplementary motor cortex, SMA）、运动前区（premotor cortex, PMC）、初级躯体感觉皮层（primary somatosensory cortex, S1）以及后顶叶皮层（posterior parietal cortex, PPC）等[15]。

       解剖学上，CST纤维自皮层下行，经过放射冠、内囊后肢，穿过脑干内侧部至延髓腹侧并形成锥体束。在延髓层面，大部分CST纤维交叉至对侧，形成皮质脊髓侧束，继续下行至各个脊髓节段[16]。源自M1、SMA、PMC的CST纤维主要投射至脊髓腹侧，而起源于S1和PPC的CST纤维则主要投射至脊髓背角[17, 18]。在脑桥区，CST的横截面积相对较小，纤维排列紧密，而延髓锥体是CST在整个中枢神经系统中所经最狭窄的区域[19]。

       CST是人体执行随意运动的主要通路，在控制对侧肢体运动中发挥关键作用[20, 21, 22]。M1是直接发出运动指令以控制肢体（尤其是手部）随意运动的主要脑区[23, 24]；SMA参与协调及规划双侧运动[23, 25]，PMC主要负责在视觉、听觉刺激下引导、计划、调整或执行运动[23, 26]；S1负责处理触觉、痛温觉、本体感觉、运动学习和控制相关信息，是整合感觉－运动的重要脑区[23, 27]；PPC参与高级运动控制、复杂认知功能处理以及运动意图的形成[23, 28]。上述脑区发出的运动指令经CST纤维（由M1、PMC、SMA、S1、PPC纤维共同构成）传递至脊髓前角运动神经元或二级传出纤维，完成运动信息传递并建立突触连接[29, 30]。

3 DTI的技术原理、核心指标、影像学表现与纤维追踪方法

3.1 技术原理

       白质纤维（white matter fibers, WMF）因髓鞘及细胞膜等结构的限制，水分子沿纤维走行方向的扩散速率快于垂直方向，表现出各向异性[31, 32]。灰质由随机朝向的树突、突触和细胞体构成，水分子各方向扩散速率基本相同，呈现出各向同性[32, 33]。DTI通过测量组织内水分子扩散的方向与速率，无创显示WMF的微观结构，已广泛应用于探索脑组织微观结构损伤与重塑机制[34, 35, 36, 37, 38]，其衍生的参数是研究MDAS与CST结构重塑的有效影像学标志物[39]。

3.2 核心指标

       DTI评估CST最常用的量化参数包括FA、MD、RD、AD。

3.2.1 FA

       FA是评估纤维束完整性最常用的指标，取值范围0~1，FA值越高表明WMF完整性、致密性以及方向一致性越好[40]。中风后病灶局部CST的FA值呈动态演变：急性期迅速下降，亚急性期缓慢回升，慢性期趋于稳定但低于正常水平[41]。临床应用中，FA值在发病4~12周对运动功能恢复的预测价值较高，但在发病3~4个月时预测作用减弱[42, 43, 44, 45, 46, 47, 48]。然而，FA值变化方向并非总与功能改善同步[13]，临床应结合MD、RD等参数进行多维度评估[49, 50]。

3.2.2 MD

       MD能反映水分子整体扩散的程度，其升高提示组织结构破坏[51]。中风急性期及亚急性早期，CST出现髓鞘脱失及轴突崩解导致MD值显著升高[52]。在亚急性和慢性期，MD值随结构重塑逐渐回落趋于稳定[53, 54]。临床常将MD与FA联合评估，FA升高伴MD降低提示运动功能恢复良好[49]。

3.2.3 AD

       AD反映水分子沿主轴方向的扩散能力，是评估轴突完整性的特异性指标[55]。中风急性期轴突损伤，AD值显著下降；亚急性期及慢性期，AD值逐渐回升但难以恢复正常[53, 56]。AD及其比率在体现中风早期轴突损伤方面具有重要意义[57]，且是预测中风患者长期运动结果的重要因素[58]。临床常以FA值与AD值均升高提示髓鞘及轴突同步改善[50]。

3.2.4 RD

       RD反映水分子在垂直于主轴方向的扩散程度，其升高提示髓鞘脱失[59]。中风亚急性期，RD值逐渐升高，对髓磷脂水平、髓鞘形成的横截面范围以及继发性髓鞘损伤较为敏感[50, 60]。临床常联合AD与RD判断轴突损伤与髓鞘脱失的相对程度。

3.3 影像学表现

       CST纤维通常表现为高各向异性信号[61, 62]。健康人的CST在DTI上表现为自放射冠至延髓锥体的连续高信号纤维束[63, 64]。不同解剖层面FA值存在差异：放射冠层面约0.45~0.65，内囊后肢及大脑脚约0.65~0.75，脑桥自喙侧（约0.45~0.60）向尾侧（约0.55~0.70）逐渐升高，脊髓节段可达0.70~0.80，锥体交叉后下降[19, 65, 66, 67, 68, 69]。彩色FA图上，放射冠呈蓝绿色，内囊后肢呈蓝色，大脑脚至脑干区域呈红色[70]。掌握上述参数范围，是评估中风后CST损伤的基础。

3.4 纤维追踪方法

       DTI纤维追踪技术可三维重建CST并进行定量分析。研究者常手动放置感兴趣区种子点，提取平均FA值并结合纤维束成像技术重建CST结构，以评估运动通路损伤程度[71, 72, 73]。但此法存在明显的主观偏差，操作可重复性较低，且偏倚风险较高，研究结果具有不稳定性[74, 75, 76]。为降低主观因素影响，纤维束示踪的空间统计（tract-based spatial statistics, TBSS）法被广泛应用。TBSS可对全脑WM结构变化进行体素水平的空间绘制[77, 78]，无须预设种子点。但该法存在配准质量误差、易丢失边缘或部分损伤区微观结构、难以精准评估个体等局限，更适用于全脑探索性研究及机制分析[79, 80]。近年来发展的沿纤维束统计分析方法，可定位CST局部损伤节点并刻画纵向演变规律[81, 82]。然而，该方法依赖先验假设，计算过程复杂且对统计校正要求较高[83, 84]，更适用于局部损伤定位或纵向比较研究。

       综上，DTI参数联合纤维追踪技术能提供中风后CST结构变化的客观数据，为针灸干预MDAS疗效评估提供影像学依据。

4 针灸干预MDAS的DTI研究证据

4.1 CST结构重塑

4.1.1 患侧CST结构重塑

       钱跃等[85]运用DTI技术发现，醒脑开窍针法相较于药物联合康复训练治疗，能显著提高MDAS患者患侧全段CST的平均FA值，并伴随简化Fugl-Meyer评分升高及美国国立卫生研究院卒中量表评分降低，提示此针法可能是通过促进CST结构重塑以改善MDAS患者的神经功能缺损，恢复其运动功能。杨福霞等[86]基于DTI观察发现，调任通督针刺治疗相较于药物治疗能显著改善MDAS患者患侧梗死灶区和患侧内囊后肢区CST的FA与相对FA值，从而改善运动功能。李静等[87]通过DTI分析发现，针刺相较于药物治疗，不仅能更显著重塑MDAS患者患侧的CST整体结构，且具有区域差异性，为针刺治疗MDAS提供了更为全面、精细的影像学证据。董莹慧等[88]亦发现东垣针法联合常规治疗较单纯常规治疗能显著改善MDAS患者患侧相对各向异性分数（relative fractional anisotropy, rFA），且能更有效地降低CST损伤评分，提示东垣针法促进CST重塑的效应优于单纯常规治疗。KIM等[89]研究发现，与常规康复训练相比，电针联合常规康复训练后MDAS患者患侧CST的FA值显著升高，提示电针可能通过促进CST结构重塑改善运动功能。

4.1.2 健侧CST结构重塑

       中枢微环境中抑制因子与神经营养因子均与CST轴突再生相关。因此，无论是健侧还是患侧的CST都可能参与轴突重塑以代偿功能损失[90]。在中风运动功能的恢复过程中，病变侧及健侧CST均存在结构可塑性。相关研究表明，中枢神经系统能自发地恢复受损肢体的运动功能，其机制与健侧CST密切相关——健侧CST在颈膨大处芽生侧支纤维，使部分神经纤维重新分布至对侧，与脊髓神经元形成突触，建立新的神经传导通路，构成肢体功能自然恢复的重要基础，且健侧CST还可能在中风早期的运动功能恢复中发挥重要作用[91, 92, 93]。李静等[94]基于DTI观察到MDAS患者接受通督调神针刺后，健侧CST顶段的FA值较治疗前显著升高，且与运动功能评分呈正相关，提示通督调神针刺可通过促进健侧CST初级运动皮质区的结构重塑发挥代偿作用，以促进运动功能恢复。朱子龙等[95]对MDAS患者行针刺治疗后，患者健侧全段CST的FA值较治疗前升高，进一步提示针刺通过促进健侧CST结构重塑以发挥代偿作用，促进运动功能恢复。

4.1.3 不同针灸方案的初步比较

       目前直接比较不同针灸方案对MDAS患者CST重塑效应的研究十分有限[10]。仅有少数研究提供了初步证据：朱子龙等[95]发现，中风促通灸联合常规针刺对患者患侧内囊后肢FA值的提升作用优于常规针刺，然而，该研究为联合治疗方案，无法分离灸法的独立效应。李伟等[96]发现，与常规针刺相比，芒针透刺督脉治疗后MDAS患者患侧CST各层面FA值升高更显著，提示芒针透刺督脉在促进全段CST重塑方面具有优势，但该研究为单中心小样本研究，具有一定局限性。因此，当前研究仅能提示穴位特异性及灸法联合针刺可能具有附加价值，尚不足以得出确定性结论，未来应设计高质量随机对照试验，系统评估穴位特异性、电针参数、干预时机及疗程等因素对DTI指标的影响，为临床精准选择针灸方案提供依据。

4.2 华勒氏变性

       CST的损伤是导致MDAS的核心原因[97, 98]。在CST的局灶性损伤中，华勒氏变性（wallerian degeneration, WD）是主要的病理机制。其始于神经细胞损伤或轴突横断，继而引发近端轴突的进行性坏死或脱髓鞘，是一种动态的病理演变过程。WD的病变程度直接影响神经功能恢复结局[99]。

       相关研究证实[100, 101]，DTI技术可观察到WD的演变过程，为临床评估提供了影像学标志物。SHEN等[102]研究发现，针刺可通过延缓WD，促进MDAS患者的运动功能与神经功能恢复。然而，该研究样本量较小，因此，“针灸延缓WD”目前仅是一个有待验证的假说。另外，值得注意的是，WD延缓与FA值升高之间可能存在因果混淆：目前借助DTI参数（如FA等）证实针灸能改善CST微观结构，但仍难以区分参数指标的变化究竟是源于针灸直接促进了轴突修复，还是通过延缓WD的进程为神经重塑赢得了“时间窗口”。

       综上所述，未来需开展更全面的高质量临床研究，联合多种DTI参数指标动态追踪CST损伤后WD的演变规律，系统探讨针灸是否通过延缓WD进程来驱动CST重塑，从而为优化针灸治疗方案、提升临床疗效提供更精准的机制依据。

4.3 非CST的白质纤维束重塑

       针灸治疗MDAS的作用机制并非局限于CST的结构重塑，其对运动网络中的多个白质束同样具有结构重塑效应。ZHAO等[103]研究发现，头针联合重复经颅磁刺激能显著提高MDAS患者弓状束、上纵束、下纵束等多个白质束的FA值，且弓状束FA值的增加与上肢运动功能评分的改善呈正相关。HAN等[104]发现，针灸能改变MDAS患者上纵束（特别是其额顶部分）的结构完整性，且上纵束FA值与下肢运动功能评分呈正相关，与美国国立卫生研究院卒中量表评分呈负相关。上述研究表明，针灸干预MDAS的作用机制涉及整体运动通路的系统性重塑，其不仅能修复CST（负责精准下传运动指令），还能同时优化弓状束、上纵束等联络纤维（与运动计划、协调密切相关）。

4.4 DTI-功能解离现象与机制探讨

       一项荟萃分析表明，针灸能显著增加中风患者全段CST的FA值[10]。大量研究[85, 86, 87, 88, 94, 95]表明，针灸可提高MDAS患者CST的FA值，且FA值变化与运动功能评分改善呈正相关。然而，并非所有研究均能证实DTI参数变化与运动功能改善之间的线性关系。LI等[12]发现针刺治疗MDAS后FMA评分的改善程度优于常规治疗，但双侧CST的各扩散指标差异均无统计学意义（仅时间主效应显著），提示功能改善与DTI结构变化可能存在时间差。而姚惠琪等[13]运用“经筋刺法”治疗MDAS，虽临床疗效已得到肯定，但DTI结果显示患者病灶区的FA值不升反降，且与运动功能评分之间不存在相关性。上述“解离”现象提示DTI参数变化与功能恢复之间并非简单的线性关系，其机制可能涉及多个层面：第一，DTI参数的变化可能受治疗时间的影响[105]；第二，DTI参数受髓鞘化程度、轴突密度等多种因素影响，单一的DTI参数难以全面揭示针灸改善MDAS患者运动功能的复杂机制[49, 50]；第三，针刺改善运动功能也可能是通过激活健侧CST纤维发挥代偿作用[94, 95]，而非直接修复受损CST；第四，运动功能恢复涉及白质纤维束种类较多[103, 104]，仅观察局部纤维的FA值可能忽视非运动通路的代偿贡献；第五，部分中枢机制变化可能无法被DTI即时且敏感地检测到，加之不同研究的样本量、病灶部位及病程存在异质性，可能导致影像学与行为学结果的不一致[10, 11, 12, 13]。上述发现提示，DTI可反映针灸治疗MDAS的作用机制具有多途径、多靶点特征，并非单一通过“促进CST主干结构重塑”而发挥作用。临床功能恢复与DTI检测到的CST结构变化之间可能存在解离，未来研究应联合多参数DTI指标及多模态影像技术，以更全面地揭示针灸的中枢效应机制。

4.5 预测针灸疗效

       DTI技术可评估CST的完整性与损伤程度，多项研究表明[106, 107, 108, 109]，中风患者患侧CST的FA值以及WD程度是预测其运动功能恢复潜力的重要影像学标志物，对临床诊疗与防治具有参考价值。因此，基于DTI评估CST完整性，可辅助预测MDAS患者针刺疗效及康复潜力，有助于指导针灸个体化治疗方案的制定。贡志刚等[110]明确提出，依据DTI可将CST损伤分为“无中断”“部分中断”和“完全中断”三级，其中，对针灸治疗反应最敏感的是CST部分中断的患者，其运动功能的改善程度也最为明显；这一发现提示，DTI可作为疗效预测的重要客观方法，对CST部分中断的患者实施针对性针灸干预，有望显著提升康复效率，为实现针灸康复的精准实施提供了客观依据。

5 小结与展望

5.1 主要结论

       本综述系统总结了DTI技术评估CST重塑在针灸治疗MDAS中的应用进展，DTI参数及纤维追踪方法在针灸治疗MDAS中的应用场景、价值与优缺点见表1。现有研究表明：第一，针灸（以针刺为主）能修复或重塑MDAS患者患侧CST结构，并对健侧CST发挥代偿作用，实现双侧协同重塑；第二，针灸治疗MDAS的作用并非仅依赖于CST结构重塑，其还能协同修复弓状束、上纵束等多条白质纤维束，体现了针灸对全脑运动网络的整体调控特点；第三，DTI参数（尤其是FA）与功能评分之间存在相关性，支持将DTI作为针灸疗效的客观影像学生物标志物，但FA值变化方向并非总是与功能改善同步，需注意“解离”现象的存在；第四，DTI技术能够预测针灸疗效，特别是对CST部分中断的患者具有重要指导价值。

表1  DTI参数及纤维追踪方法在针灸治疗MDAS中的应用场景、价值与优缺点
Tab. 1  Application scenarios, values, advantages, and disadvantages of DTI parameters and fiber tractography methods in acupuncture treatment for MDAS

5.2 研究局限性

       目前，基于DTI技术探索针灸干预MDAS的相关研究仍存在以下不足：其一，DTI参数单一。多数研究仅报告FA值，缺乏AD、RD等特异性指标，难以区分轴突与髓鞘的各自贡献，存在较大偏倚风险。其二，研究方案异质性大。目前探索针灸治疗MDAS中枢机制的研究大多聚焦于对比针灸与其他疗法，例如针灸与西药、针灸与康复、针灸与综合治疗等，无法直接诠释不同针灸方案、不同电针参数、不同治疗疗程的差异性作用机制，无法进行有效分析。其三，样本量不足。目前绝大多数研究多采用单中心小样本的随机对照试验，缺乏多中心大样本随机对照试验以及前瞻性队列研究。其四，样本量估算缺乏统一标准。绝大多数研究未能规范报告样本量估算依据，增加了结果偶然性风险。其五，“针灸延缓WD”假说的直接证据极为薄弱，需更多高质量纵向研究验证。其六，随访缺失。绝大多数研究未能报道针灸后CST改变的长期可持续性。

       就纳入文献的证据等级而言，本综述按照牛津循证医学中心证据等级标准，对第4章针灸干预MDAS的DTI研究证据中引用的15项核心临床研究进行分级（Ⅰ级为随机对照试验的系统评价；Ⅱ级为随机对照试验或效果显著的观察性研究；Ⅲ级为非随机对照的队列研究；Ⅳ级为非随机试验、病例系列、病例对照、历史对照研究；Ⅴ级为基于机制的推论、单纯专家观点）。分级结果显示：Ⅰ级证据1篇（6.7%），为ZHU等[10]发表的Meta分析；Ⅱ级11篇（73.3%），包括LI等[12]、钱跃等[85]、杨福霞等[86]、李静等[87]、董莹慧等[88]、KIM等[89]、李静等[94]、朱子龙等[95]、李伟等[96]、SHEN等[102]及ZHAO等[103]的小样本随机对照试验；Ⅲ级1篇（6.7%），为贡志刚等[110]的非随机对照分层观察研究，Ⅳ级2篇（13.3%），包括HAN等[104]和姚惠琪等[13]的非对照试验。上述分级结果进一步印证了当前方法学的普遍缺陷：其一，多数RCT未规范报告样本量估算依据；其二，未报告盲法或无法设置盲法，偏倚风险较高；其三，干预方案差异性较大，难以进行直接比较或汇总分析；其四，绝大多数研究缺乏长期随访，DTI参数的可持续性变化尚不明确。综上所述，当前证据虽初步支持针灸调控CST重塑改善MDAS，但整体证据等级偏低、方法学质量参差不齐。

5.3 未来研究方向

       第一，开展高质量循证研究，严格遵循CONSORT声明。详细报告研究设计、随机化方法、盲法、样本量估算以及随访方案，开展高质量多中心大样本随机对照试验或前瞻性队列研究，特别应设计针刺与灸法的独立效应研究。第二，整合多种DTI参数。联合能反映髓鞘以及轴索状态的指标（AD、RD、MD），多参数综合评估，精准定位针灸作用靶点。第三，多学科交叉研究。联合静息态磁共振技术、动脉自旋标记技术、分子影像学以及血清生物标记物，多维度地深入诠释针灸治疗MDAS的作用机制，阐明DTI指标与运动功能“解离”的内在原因，更全面地揭示针灸对大脑的整体调控作用。第四，加强临床精准指导。系统地探索不同针刺参数（如取穴、手法、刺激量、治疗时机等）、针灸疗程及方案等因素对DTI指标的影响，以便建立更加优化、多元化、标准化的MDAS针灸疗法。第五，拓展影像学前沿方法。现阶段可进一步拓展更先进的扩散成像模型，如神经突方向离散度与密度成像（neurite orientation dispersion and density imaging, NODDI）和扩散谱成像（diffusion spectrum imaging, DSI）。NODDI可定量提供神经突密度指数、方向离散度指数及游离水分数等多个微结构参数，分别反映轴突、树突的密集程度、纤维走向的离散程度以及组织内自由水的占比[111]，相较于传统DTI，能够更加特异地反映轴突密度与纤维走行的微细改变[112]。DSI则通过多壳层扩散采样方式，对病变脑组织的微结构损伤更为敏感，且在识别多方向、交叉纤维走行时具有更高的准确性和精确性[113]，在脑卒中后纤维重塑研究中具有优势[114]。目前这两项技术尚无应用于针灸治疗MDAS的相关研究，但其在评估脑组织损伤与重塑方面具有独特优势，可为后续机制研究提供全新、可靠的影像学研究方向。

[1]
高树中, 冀来喜. 针灸治疗学[M]. 北京: 中华中医药出版社, 2021: 40-42.
GAO S Z, JI L X. Acupuncture and moxibustion therapeutics[M]. Beijing: China Traditional Chinese Medicine Press, 2021: 40-42.
[2]
令泽琨, 杨华清, 解焕鑫, 等. 脑卒中偏瘫患者下肢痉挛的治疗[J]. 中国临床医生杂志, 2025, 53(5): 540-544. DOI: 10.3969/j.issn.1008-1070.2025.05.002.
LING Z K, YANG H Q, XIE H X, et al. Treatment of lower limb spasticity in stroke patients with hemiplegia[J]. Chinese Journal for Clinicians, 2025, 53(5): 540-544. DOI: 10.3969/j.issn.1008-1070.2025.05.002.
[3]
National Center for Cardiovascular Diseases The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on Cardiovascular Health and Diseases in China 2023: An Updated Summary[J]. Biomed Environ Sci, 2024, 37(9): 949-992. DOI: 10.3967/bes2024.162.
[4]
CHEN J L, LAM T K, BANINA M C, et al. Neuroimaging and kinematic biomarkers of post-stroke upper limb motor impairment[J/OL]. Neuroimage Clin, 2025, 48: 103854 [2026-02-27]. https://doi.org/10.1016/j.nicl.2025.103854. DOI: 10.1016/j.nicl.2025.103854.
[5]
WEN J, LIANG Z, LI C, et al. Motor-cognitive aging: The role of motor cortex and its pathways[J/OL]. Neuroimage, 2025, 320: 121472 [2026-02-27]. https://doi.org/10.1016/j.neuroimage.2025.121472. DOI: 10.1016/j.neuroimage.2025.121472.
[6]
WANG L, YUAN W, HOU H, et al. Effect of upper-limb robot-assisted therapy combined with pneumatic gloves on upper limb function in young and middle-aged stroke patients: a pilot randomized controlled trial[J/OL]. J Neuroeng Rehabil, 2025, 22(1): 243 [2026-02-27]. https://doi.org/10.1186/s12984-025-01785-8. DOI: 10.1186/s12984-025-01785-8.
[7]
JIANG H X, WANG Y, ZHANG J Y, et al. Structures of the nerve fiber bundles near the central sulcus on diffusion tensor imaging[J]. IBRO Neurosci Rep, 2025, 19: 749-759. DOI: 10.1016/j.ibneur.2025.07.015.
[8]
DING L, ZHANG K, WANG X, et al. Functional reorganization of white matter supporting the transhemispheric mechanism of mirror therapy after stroke: A multimodal MRI study[J]. IEEE Trans Neural Syst Rehabil Eng, 2025, 33: 1126-1134. DOI: 10.1109/TNSRE.2025.3549380.
[9]
CHEN W, XIE G, XU C, et al. The relationship between changes in white matter microstructure and cognition in untreated major depressive disorder[J/OL]. J Affect Disord, 2025, 390: 120027 [2026-02-27]. https://doi.org/10.1016/j.jad.2025.120027. DOI: 10.1016/j.jad.2025.120027.
[10]
ZHU W, DENG S, JIANG H, et al. Assessment of corticospinal tract remodeling based on diffusion tensor imaging in the treatment of motor dysfunction after ischemic stroke by acupuncture: A meta-analysis[J/OL]. Medicine (Baltimore), 2023, 102(32): e34618 [2026-02-27]. https://doi.org/10.1097/MD.0000000000034618. DOI: 10.1097/MD.0000000000034618.
[11]
吴越, 曹丹娜. 针刺治疗脑梗死脑中枢机制的功能磁共振成像研究进展[J]. 辽宁中医杂志, 2023, 50(6): 243-246. DOI: 10.13192/j.issn.1000-1719.2023.06.067.
WU Y, CAO D N. Research progress on functional magnetic resonance imaging of central mechanism of acupuncture treatment for cerebral infarction[J]. Liaoning Journal of Traditional Chinese Medicine, 2023, 50(6): 243-246. DOI: 10.13192/j.issn.1000-1719.2023.06.067.
[12]
LI Y, WANG Y, ZHANG H, et al. The Effect of Acupuncture on the Motor Function and White Matter Microstructure in Ischemic Stroke Patients[J/OL]. Evid Based Complement Alternat Med, 2015, 2015: 164792 [2026-02-27]. https://doi.org/10.1155/2015/164792. DOI: 10.1155/2015/164792.
[13]
姚惠琪, 张思裕, 曾妍, 等. 弥散张量成像与经筋刺法针刺治疗脑卒中后肌痉挛患者后肢体运动功能的关系[J]. 医药前沿, 2025, 15(27): 83-87. DOI: 10.20235/j.issn.2095-1752.2025.27.021.
YAO H Q, ZHANG S Y, ZENG Y, et al. The relationship between diffusion tensor imaging and the motor function of the hind limbs in patients with muscle spasm after stroke treated by acupuncture[J]. Journal of Frontiers of Medicine, 2025, 15(27): 83-87. DOI: 10.20235/j.issn.2095-1752.2025.27.021.
[14]
CHEN X, LIU M, YANG X, et al. Research hotspots and trends in the application of diffusion tensor imaging in ischemic stroke: a bibliometric analysis (2003-2024)[J/OL]. Front Neurol, 2025, 16: 1579598 [2026-02-27]. https://doi.org/10.3389/fneur.2025.1579598. DOI: 10.3389/fneur.2025.1579598.
[15]
USUDA N, SUGAWARA S K, TAZOE T, et al. Quantitative comparison of uncrossed corticospinal tracts arising from different cortical areas in humans[J]. Neurosci Res, 2025, 219: 104954 [2026-02-27]. https://doi.org/10.1016/j.neures.2025.104954. DOI: 10.1016/j.neures.2025.104954.
[16]
DAULEAC C, BOUKHARI A, JACQUESSON T, et al. Stitching brain and spinal cord DTI using cross-correlation registration: toward an atlas of spinal tracts[J/OL]. Eur Radiol Exp, 2025, 9(1): 112 [2026-02-27]. https://doi.org/10.1186/s41747-025-00647-1. DOI: 10.1186/s41747-025-00647-1.
[17]
BRAAß H, WOLF S, FELDHEIM J, et al. Altered functional connectivity between cortical premotor areas and the spinal cord in chronic stroke[J]. Stroke, 2025, 56(5): 1159-1168. DOI: 10.1161/STROKEAHA.124.048384.
[18]
LEMON R N, GRIFFITHS J. Comparing the function of the corticospinal system in different species: organizational differences for motor specialization?[J]. Muscle Nerve, 2005, 32: 261-279. DOI: 10.1002/mus.20333.
[19]
SEO J P, JANG S H. Characteristics of corticospinal tract area according to pontine level[J]. Yonsei Med J, 2013, 54(3): 785-787. DOI: 10.3349/ymj.2013.54.3.785.
[20]
DARVISH M R, SUNG J, WILLIAMSON J N, et al. The role of hemispheric sensory shifts: Impacts on stretch reflex and motor plasticity post-stroke[J/OL]. Med Hypotheses, 2025, 199: 111653 [2026-02-27]. https://doi.org/10.1016/j.mehy.2025.111653. DOI: 10.1016/j.mehy.2025.111653.
[21]
WILLIAMSON J N, MULYANA B, PENG R H, et al. How the somatosensory system adapts to the motor change in stroke: A hemispheric shift?[J/OL]. Med Hypotheses, 2024, 192: 111487 [2026-02-27]. https://doi.org/10.1016/j.mehy.2024.111487. DOI: 10.1016/j.mehy.2024.111487.
[22]
ROZE E, DUBACQ C, WELNIARZ Q. Corticospinal tract development, evolution, and skilled movement[J]. Mov Disord, 2025, 40(7): 1221-1232. DOI: 10.1002/mds.30199.
[23]
莫宏伟. 脑科学导论[M]. 北京: 人民邮电出版社, 2023: 245.
MO H W. Introduction to Brain Science[M]. Beijing: People's Post and Telecommunication,2023: 245.
[24]
LEE C, KIM Y, KAANG B K. The primary motor cortex: The hub of motor learning in rodents[J]. Neuroscience, 2022, 485: 163-170. DOI: 10.1016/j.neuroscience.2022.01.009.
[25]
帕力丹木·吾买尔, 阿里木江·阿卜杜凯尤木, 维克拉木江·祖农, 等. 功能磁共振成像在帕金森病患者四肢联动训练时脑功能活动区的协同作用研究[J]. 磁共振成像, 2023, 14(10): 31-35, 41. DOI: 10.12015/j.issn.1674-8034.2023.10.007.
WUMAIER P, ABDUKAYUM A, ZUNONG W, et al. The synergistic effect of functional magnetic resonance imaging in the brain functional activity area of patients with Parkinson's disease during limb linkage training[J]. Chin J Magn Reson Imaging, 2023, 14(10): 31-35, 41. DOI: 10.12015/j.issn.1674-8034.2023.10.007.
[26]
FINE J M, HAYDEN B Y. The whole prefrontal cortex is premotor cortex[J/OL]. Philos Trans R Soc Lond B Biol Sci, 2022, 377(1844): 20200524 [2026-02-27]. https://doi.org/10.1098/rstb.2020.0524. DOI: 10.1098/rstb.2020.0524.
[27]
HUANG Y, ZHANG X, LI W. Involvement of primary somatosensory cortex in motor learning and task execution[J/OL]. Neurosci Lett, 2024, 828: 137753 [2026-02-27]. https://doi.org/10.1016/j.neulet.2024.137753. DOI: 10.1016/j.neulet.2024.137753.
[28]
高小雨, 田甜, 王潇, 等. 基于fMRI探究针刺对无先兆偏头痛患者脑功能活动的影响[J]. 中国中西医结合影像学杂志, 2025, 23(2): 185-190, 207. DOI: 10.3969/j.issn.1672-0512.2025.02.012.
GAO X Y, TIAN T, WANG X, et al. Based on fMRI to explore the effect of acupuncture on brain function in patients with migraine without aura[J]. Chinese Imaging Journal of Integrated Traditional and Western Medicine, 2025, 23(2): 185-190, 207. DOI: 10.3969/j.issn.1672-0512.2025.02.012.
[29]
ALAWIEH A, TOMLINSON S, ADKINS D, et al. Preclinical and clinical evidence on ipsilateral corticospinal projections: Implication for motor recovery[J]. Transl Stroke Res, 2017, 8(6): 529-540. DOI: 10.1007/s12975-017-0551-5.
[30]
陈钰昕, 吕雪靖, 胡理. 主动运动和被动运动的镇痛效果及其镇痛机制[J]. 生物化学与生物物理进展, 2020, 47(6): 498-509. DOI: 10.16476/j.pibb.2020.0021.
CHEN Y X, LV X J, HU L. The analgesic effect of active and passive exercise and its analgesic mechanism[J]. Progress in Biochemistry and Biophysics, 2020, 47(06): 498-509. DOI: 10.16476/j.pibb.2020.0021.
[31]
MOSELEY M E, COHEN Y, KUCHARCZYK J, et al. Diffusion-weighted MR imaging of anisotropic water diffusion in cat central nervous system[J]. Radiology, 1990, 176(2): 439-445. DOI: 10.1148/radiology.176.2.2367658.
[32]
BEAULIEU C. The basis of anisotropic water diffusion in the nervous system - a technical review[J]. NMR Biomed, 2002, 15(7-8): 435-55. DOI: 10.1002/nbm.782.
[33]
CHENEVERT T L, BRUNBERG J A, PIPE J G. Anisotropic diffusion in human white matter: demonstration with MR techniques in vivo[J]. Radiology, 1990, 177(2): 401-405. DOI: 10.1148/radiology.177.2.2217776.
[34]
FIGLEY C R, UDDIN M N, WONG K, et al. Potential pitfalls of using fractional anisotropy, axial diffusivity, and radial diffusivity as biomarkers of cerebral white matter microstructure[J/OL]. Front Neurosci, 2022, 15: 799576 [2026-02-27]. https://doi.org/10.3389/fnins.2021.799576. DOI: 10.3389/fnins.2021.799576.
[35]
WANG M, ZHU H, HUANG T, et al. MRI assessment of geometric microstructural changes of white matter in infants with periventricular white matter injury and spastic cerebral palsy[J]. Magn Reson Imaging, 2025, 62(2): 403-414. DOI: 10.1002/jmri.29730.
[36]
PURI A, KUMAR S. Voxel-Specific eigenvalue approach for improved fiber orientation estimation in diffusion MRI[J]. NMR Biomed, 2026, 39(2): e70217 [2026-02-27]. https://doi.org/10.1002/nbm.70217. DOI: 10.1002/nbm.70217.
[37]
CABEZAS-RODRÍGUEZ J A, BIARNES C, MARTÍ-NAVAS M, et al. Diffusion tensor imaging study after intraarterial cell therapy in acute ischemic stroke: A substudy of the IBIS randomized clinical trial[J]. Stroke, 2025, 56(8): 2198-2209. DOI: 10.1161/STROKEAHA.124.050261.
[38]
李欣璐, 张函夕, 杨明, 等. 扩散张量成像技术在阿尔茨海默病病理进程中的应用[J]. 分子影像学杂志, 2025, 48(8): 1028-1033. DOI: 10.12015/issn.1674-8034.2025.08.017.
LI X L, ZHANG H X, YANG M, et al. Application of diffusion tensor imaging in the pathological process of Alzheimer's disease[J]. Journal of Molecular Imaging, 2025, 48(8): 1028-1033. DOI: 10.12015/issn.1674-8034.2025.08.017.
[39]
LOUBINOUX I, LAFUMA M, RIGAL J, et al. Diffusion tensor imaging and gray matter volumetry to evaluate cerebral remodeling processes after a pure motor stroke: a longitudinal study[J]. Neurol. 2024, 271(10): 6876-6887. DOI: 10.1007/s00415-024-12648-y.
[40]
LAURELL A A S, MAK E, O'BRIEN J T. A systematic review of diffusion tensor imaging and tractography in dementia with Lewy bodies and Parkinson's disease dementia[J/OL]. Neurosci Biobehav Rev, 2025, 169: 106007 [2026-02-27]. https://doi.org/10.1016/j.neubiorev.2025.106007. DOI: 10.1016/j.neubiorev.2025.106007.
[41]
THONMALLA G, GLAUCHE V, WEILLER C, et al. Time course of wallerian degeneration after ischaemic stroke revealed by diffusion tensor imaging[J]. J Neurol Neurosurg Psychiatry, 2005, 76(2): 266-268. DOI: 10.1136/jnnp.2004.046375.
[42]
MAGOUNI M, ASTAKAS L G, ELACH S, et al. Integrated neuroimaging and robotic rehabilitation in chronic stroke: Neural correlates and predictors of motor recovery[J/OL]. Exp Ther Med, 2025, 30(4): 182 [2026-02-27]. https://doi.org/10.3892/etm.2025.12932. DOI: 10.3892/etm.2025.12932.
[43]
CHEN J, LI C, HONG J, et al. High-Frequency repetitive transcranial magnetic stimulation enhances white matter integrity in a rat model of ischemic stroke: A diffusion tensor imaging study using tract-based spatial statistics[J/OL]. Neuroimage, 2025, 311: 121204 [2026-02-27]. https://doi.org/10.1016/j.neuroimage.2025.121204. DOI: 10.1016/j.neuroimage.2025.121204.
[44]
DOUGHTY C, WANG J, FENG W, et al. Detection and predictive value of fractional anisotropy changes of the corticospinal tract in the acute phase of a stroke[J]. Stroke, 2016, 47(6): 1520-1526. DOI: 10.1161/STROKEAHA.115.012088.
[45]
ZHAO X, RUAN J, LI B, et al. Atlas-based analysis of diffusion imaging may predict efficacy of forelimb movement therapy for motor recovery in post-stroke rats[J/OL]. Neuroimage, 2025, 321: 121517 [2026-02-27]. https://doi.org/10.1016/j.neuroimage.2025.121517. DOI: 10.1016/j.neuroimage.2025.121517.
[46]
BUTET S, FLEURY M, DUCHÉ Q, et al. EEG-fMRI neurofeedback versus motor imagery after stroke, a randomized controlled trial[J/OL]. J Neuroeng Rehabil, 2025, 22(1): 67[2025-12-22]. https://doi.org/10.1186/s12984-025-01598-9. DOI: 10.1186/s12984-025-01598-9.
[47]
LIU J, SHAN Y, CUI B X, et al. Prediction of motor recovery after subacute cerebral infarction: Role of corticocerebellar pathway integrity[J]. Neurorehabil Neural Repair, 2025, 39(9): 765-775. DOI: 10.1177/15459683251351879.
[48]
KOYAMA T, MOCHIZUKI M, UCHIYAMA Y, et al. Outcome prediction by combining corticospinal tract lesion load with diffusion-tensor fractional anisotropy in patients after hemorrhagic stroke[J/OL]. Prog Rehabil Med, 2024, 9: 20240001 [2026-02-27]. https://doi.org/10.2490/prm.20240001. DOI: 10.2490/prm.20240001.
[49]
YU C, ZHU C, ZHANG Y, et al. A longitudinal diffusion tensor imaging study on Wallerian degeneration of corticospinal tract after motor pathway stroke[J]. Neuroimage, 2009, 47(2): 451-458. DOI: 10.1016/j.neuroimage.2009.04.066.
[50]
OEY N E, SAMUEL G S, LIM J K W, et al. Whole brain white matter microstructure and upper limb function: Longitudinal changes in fractional anisotropy and axial diffusivity in post-stroke patients[J]. J Cent Nerv Syst Dis, 2019, 11: 1-9. DOI: 10.1177/1179573519863428.
[51]
PETERS D M, FRIDRIKSSON J, RICHARDSON J D, et al. Upper and lower limb motor function correlates with ipsilesional corticospinal tract and red nucleus structural integrity in chronic stroke: A cross-sectional, ROI-based MRI study[J/OL]. Behav Neurol, 2021, 2021: 3010555 [2026-02-27]. https://doi.org/10.1155/2021/3010555. DOI: 10.1155/2021/3010555.
[52]
MØLLER M, FRANDSEN J, ANDERSEN G, et al. Dynamic changes in corticospinal tracts after stroke detected by fibretracking[J]. J Neurol Neurosurg Psychiatry, 2007, 78(6): 587-592. DOI: 10.1136/jnnp.2006.100248.
[53]
BOUCHER J, MARCOTTE K, BEDETTI C, et al. Longitudinal evolution of diffusion metrics after left hemisphere ischaemic stroke[J/OL]. Brain Commun, 2023, 5(6): fcad313 [2026-02-27]. https://doi.org/10.1093/braincomms/fcad313. DOI: 10.1093/braincomms/fcad313.
[54]
HAQUE M E, HASAN K M, GEORGE S, et al. Longitudinal neuroimaging evaluation of the corticospinal tract in patients with stroke treated with autologous bone marrow cells[J]. Stem Cells Transl Med, 2021, 10(7): 943-955. DOI: 10.1002/sctm.20-0369.
[55]
买丽, 李孝忠, 伍东洋, 等. 磁共振扩散峰度成像在抑郁症患者脑白质微结构中的研究进展[J]. 磁共振成像, 2026, 17(1): 134-139. DOI: 10.12015/issn.1674-8034.2026.01.021.
MAI L, LI X Z, WU D Y, et al. Research progress of magnetic resonance diffusion kurtosis imaging in white matter microstructure of patients with depression[J]. Chin J Magn Reson Imaging, 2026, 17(1): 134-139. DOI: 10.12015/issn.1674-8034.2026.01.021.
[56]
ZEDDE M, GRISENDI I, ASSENZA F, et al. Stroke-induced secondary neurodegeneration of the corticospinal tract-time course and mechanisms underlying signal changes in conventional and advanced magnetic resonance imaging[J/OL]. J Clin Med, 2024, 13(7): 1969 [2026-02-27]. https://doi.org/10.3390/jcm13071969. DOI: 10.3390/jcm13071969.
[57]
MOULTON E, AMOR-SAHLI M, PERLBARG V, et al. Axial diffusivity of the corona radiata at 24 hours post-stroke: A new biomarker for motor and global outcome[J/OL]. PLoS One, 2015, 10(11): e0142910 [2026-02-27]. https://doi.org/10.1371/journal.pone.0142910. DOI: 10.1371/journal.pone.0142910.
[58]
MOULTON E, MAGNO S, VALABREGUE R, et al. Acute diffusivity biomarkers for prediction of motor and language outcome in mild-to-severe stroke patients[J]. Stroke, 2019, 50(8): 2050-2056. DOI: 10.1161/STROKEAHA.119.024946.
[59]
SONG S K, SUN S W, RAMSBOTTOM M J, et al. Dysmyelination revealed through MRI as increased radial (but unchanged axial) diffusion of water[J]. Neuroimage, 2002, 17(3): 1429-1436. DOI: 10.1006/nimg.2002.1267.
[60]
KIRBY E D, FRIZZELL T O, GRAJAUSKAS L A, et al. Increased myelination plays a central role in white matter neuroplasticity[J/OL]. Neuroimage, 2022, 263: 119644 [2026-02-27]. https://doi.org/10.1016/j.neuroimage.2022.119644. DOI: 10.1016/j.neuroimage.2022.119644.
[61]
CHOE A S, STEPNIEWAKA I, COLVIN D C, et al, Validation of diffusion tensor MRI in the central nervous system using light microscopy: quantitative comparison of fiber properties[J]. NMR Biomed, 2012, 25(7): 900-908. DOI: 10.1002/nbm.1810.
[62]
FRIEDRICH P, FRAENZ C, SCHLÜTER C, et al. The relationship between axon density, myelination, and fractional anisotropy in the human corpus callosum[J]. Cereb Cortex, 2020, 30(4): 2042-2056. DOI: 10.1093/cercor/bhz221.
[63]
MORI S, ZHAN J. Principles of diffusion tensor imaging and its applications to basic neuroscience research[J]. Neuron, 2006, 51(5): 527-539. DOI: 10.1016/j.neuron.2006.08.012.
[64]
WAKANA S, JIANG H, NAGAE-POETSCHER L M, et al. Fiber tract-based atlas of human white matter anatomy[J]. Radiology, 2004, 230(1): 77-87. DOI: 10.1148/radiol.2301021640.
[65]
BOYNE P, WILLAMSON B, BUCLEZ J, et al. Probabilistic normative maps of the corticospinal and cortico-reticulospinal tracts in streamline and volumetric formats[J/OL]. J Neurosci Methods, 2025, 423: 110549 [2026-02-27]. https://doi.org/10.1016/j.jneumeth.2025.110549. DOI: 10.1016/j.jneumeth.2025.110549.
[66]
张玮, 余庆华, 林圣美, 等. DTI检测正常人皮质脊髓束发育规律[J]. 中国医学影像技术, 2014, 30(11): 1628-1631. DOI: 10.13929/j.1003-3289.2014.11.007.
ZHANG W, YU Q H, LIN S M, et al. DTI detects the developmental pattern of normal human corticospinal tract[J]. Chinese Journal of Medical Imaging Technology, 2014, 30(11): 1628-1631. DOI: 10.13929/j.1003-3289.2014.11.007.
[67]
扶宇, 曹付强, 王本瀚, 等. 扩散张量成像示踪技术在正常成人中脑纤维束中的应用[J]. 实用放射学杂志, 2021, 37(6): 877-880. DOI: 10.3969/j.issn.1002-1671.2021.06.001.
FU Y, CAO F Q, WANG B H, et al. Application of diffusion tensor imaging tracing technique in normal adult midbrain fiber bundles[J]. Journal of Practical Radiology, 2021, 37(6): 877-880. DOI: 10.3969/j.issn.1002-1671.2021.06.001.
[68]
周慧玲, 陈莉, 钟向凯, 等. 基于TBSS分析腰椎间盘突出所致慢性腰痛患者的脑白质结构改变[J]. 川北医学院学报, 2024, 39(7): 882-887. DOI: 10.3969/j.issn.1005-3697.2024.07.004.
ZHOU H L, CHEN L, ZHONG X K, et al. Revealing cerebral white matter structural changes in, patients with chronic low back pain caused by Lumbar, disc herniation based on TBSS[J]. Journal of North Sichuan Medical College, 2024, 39(7): 882-887. DOI: 10.3969/j.issn.1005-3697.2024.07.004.
[69]
CHAGAWA K, NISHIJIMA S, KANCHIKU T, et al. Normal values of diffusion tensor magnetic resonance imaging parameters in the cervical spinal cord[J]. Asian Spine J, 2015, 9(4): 541-547. DOI: 10.4184/asj.2015.9.4.541.
[70]
LEE A L. Advanced imaging of traumatic brain injury[J]. Korean J Neurotrauma, 2020, 16(1): 3-17. DOI: 10.13004/kjnt.2020.16.e12.
[71]
WANG A J, ROH C H, KO M H, et al. Objective motor function assessment using diffusion tensor tractography in subacute acquired brain injury: A retrospective observational study[J/OL]. Medicine (Baltimore), 2025, 104(52): e46721 [2026-02-27]. http://dx.doi.org/10.1097/MD.0000000000046721. DOI: 10.1097/MD.0000000000046721.
[72]
SHI M, CHEN H, CI X, et al. Assessment of corticospinal tract damage and cytokines response in early and late stages of acute unilateral brainstem infarction patients[J/OL]. Front Immunol, 2024, 15: 1504626 [2026-02-27]. http://doi.org/10.3389/fmmu.2024.1504626. DOI: 10.3389/fimmu.2024.1504626.
[73]
于子夫, 杨晓霞, 赵霞, 等. 头针联合皮内针同步康复疗法对脑卒中患者上肢运动功能的效果[J]. 中国康复理论与实践, 2025, 31(10): 1194-1205. DOI: 10.3969/j.issn.1006-9771.2025.10.011.
YU Z F, YANG X X, ZHAO X, et al. Effect of scalp acupuncture combined with intradermal needle synchronous rehabilitation therapy on upper limb motor function in stroke patients[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1194-1205. DOI: 10.3969/j.issn.1006-9771.2025.10.011.
[74]
JANKO M, SANTANIELLO S D, BROCKMANN C, et al. Comparison of T1-weighted landmark placement and ROI transfer onto diffusion-weighted EPI sequences for targeted tractography tasks in the optic nerve[J]. Eur J Neurosci, 2024, 60(5): 4987-4999. DOI: 10.1111/ejn.16490.
[75]
CAMPAÑA PERILLA L A, MAHECHA CARVAJAL M E, CARDONA ORTEGÓN J D, et al. Diffusion tensor imaging protocol: The need for standardization of measures[J/OL]. Radiology, 2023, 308(2): e230470 [2026-02-27]. http://doi.org/10.1148/radiol.230470. DOI: 10.1148/radiol.230470.
[76]
LOCKARD C A, HOOIJMANS M T, ZHOU X, et al. The impact of diffusion tensor imaging tractography settings on muscle fascicle architecture and diffusion parameter estimates: Tract length, completion, and curvature are most sensitive to tractography settings[J/OL]. NMR Biomed, 2024, 37(11): e5205 [2026-02-27]. https://doi.org/10.1002/nbm.5205. DOI: 10.1002/nbm.5205.
[77]
YANG M, CHEN G, LUO C, et al. White matter microstructure abnormalities in thalassemia patients using TBSS analysis based on DTI[J/OL]. Sci Rep, 2025, 15(1): 17929 [2026-02-27]. https://doi.org/10.1038/s41598-025-99505-8. DOI: 10.1038/s41598-025-99505-8.
[78]
ZHANG Q, WANG D, WU S, et al. Diffuse tract damage correlates with global cognitive impairment in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: A tract-based spatial statistics study[J]. J Comput Assist Tomogr, 2021, 45(2): 285-293. DOI: 10.1097/RCT.0000000000001129.
[79]
KARIMI D, KEBIRI H, GHOLIPOUR A. TBSS++: A novel computational method for tract-based spatial statistics[J/OL]. bioRxiv [Preprint], 2023, 2023.07.10.548454 [2026-02-27]. https://doi.org/10.1101/2023.07.10.548454. DOI: 10.1101/2023.07.10.548454.
[80]
MZAYEK Y, DE RUITER M B, OLDENBURG H S A, et al. Measuring decline in white matter integrity after systemic treatment for breast cancer: Omitting skeletonization enhances sensitivity[J]. Brain Imaging Behav, 2021, 15(3): 1191-1200. DOI: 10.1007/s11682-020-00319-1.
[81]
LI J, WEI X H, LIU Y K, et al. Evidence of motor injury due to damaged corticospinal tract following acute hemorrhage in the basal ganglia region[J/OL]. Sci Rep, 2020, 10(1): 16346 [2026-02-27]. https://doi.org/10.1038/s41598-020-73305-8. DOI: 10.1038/s41598-020-73305-8.
[82]
ZHANG H, ZHAO J, FAN L, et al. Exploring the structural plasticity mechanism of corticospinal tract during stroke rehabilitation based automated fiber quantification tractography[J]. Neurorehabil Neural Repair, 2024, 38(6): 425-436. DOI: 10.1177/15459683241249115.
[83]
DELL'ACQUA F, LEEMANS A, ZHANG F, et al. The tractographer's dilemma: Understanding sources of variability in tractography[J/OL]. Brain Struct Funct, 2025, 230(6): 99 [2026-02-27]. https://doi.org/10.1007/s00429-025-02964-y. DOI: 10.1007/s00429-025-02964-y.
[84]
ZHENG R, ZHANG W, LI Y, et al. AGFS-tractometry: A novel atlas-guided fine-scale tractometry approach for enhanced along-tract group statistical comparison using diffusion MRI tractography[J/OL]. Med Image Anal, 2026, 109: 103892 [2026-02-27]. https://doi.org/10.1016/j.media.2025.103892. DOI: 10.1016/j.media.2025.103892.
[85]
钱跃, 谢波, 闫显栋. 醒脑开窍针法对缺血性脑卒中患者皮质脊髓束及运动功能影响的临床观察[J]. 中国中医药现代远程教育, 2024, 22(22): 133-136. DOI: 10.3969/j.issn.1672-2779.2024.22.041.
QIAN Y, XIE B, YAN X D. Clinical observation on the effect of Xingnao Kaiqiao acupuncture on corticospinal tract and motor function in patients with ischemic stroke[J]. Chinese Medicine Modern Distance Education of China, 2024, 22(22): 133-136. DOI: 10.3969/j.issn.1672-2779.2024.22.041.
[86]
杨福霞, 侯冬梅, 高进云, 等. 针刺对脑梗死后运动功能与各部位皮质脊髓束的影响[J]. 中华中医药杂志, 2021, 36(11): 6888-6892. DOI: 10.1673-1727.2021.11.6888.
YANG F X, HOU D M, GAO J Y, et al. Effect of acupuncture on motor function and corticospinal tract after cerebral infarction[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2021, 36 (11): 6888-6892. DOI: 10.1673-1727.2021.11.6888.
[87]
李静, 刘永康, 厉励, 等. 基于结构MRI探讨针刺对脑卒中偏瘫患者皮质脊髓束重塑的影响[J]. 磁共振成像, 2020, 11(2): 99-103. DOI: 10.12015/issn.1674-8034.2020.02.005.
LI J, LIU Y K, LI L, et al. To explore the effect of acupuncture on corticospinal tract remodeling in stroke patients with hemiplegia based on structural MRI[J]. Chin J Magn Reson Imaging, 2020, 11(2): 99-103. DOI: 10.12015/issn.1674-8034.2020.02.005.
[88]
董莹慧, 张立杰. 东垣针法对缺血性脑卒中后偏瘫患者运动功能及皮质脊髓束损伤的影响研究[J]. 针灸临床杂志, 2023, 39(8): 14-18. DOI: 10.19917/j.cnki.1005-0779.023150.
DONG Y H, ZHANG L J. Effect of Dongyuan acupuncture on motor function and corticospinal tract injury in patients with hemiplegia after ischemic stroke[J]. Journal of Clinical Acupuncture and Moxibustion, 2023, 39(8): 14-18. DOI: 10.19917/j.cnki.1005-0779.023150.
[89]
KIM M S, MOON B S, AHN J Y, et al. Elucidating the mechanisms of post-stroke motor recovery mediated by electroacupuncture using diffusion tensor tractography[J/OL]. Front Neurol, 2022, 13: 888165 [2026-02-27]. https://doi.org/10.3389/fneur.2022.888165. DOI: 10.3389/fneur.2022.888165.
[90]
黄麟荇, 刘宪楚, 易丽贞, 等. 脑卒中痉挛后皮质脊髓束轴突重塑相关机制的研究进展[J]. 神经解剖学杂志, 2025, 41(5): 684-688. DOI: 10.16557/j.cnki.1000-7547.2025.05.021.
HUANG L X, LIU X C, YI L Z, et al. Research progress on the mechanism of axonal remodeling of corticospinal tract after stroke spasm[J]. Chinese Journal of Neuroanatomy, 2025, 41(5): 684-688. DOI: 10.16557/j.cnki.1000-7547.2025.05.021.
[91]
李锡君, 余成新, 赵长江, 等. fMRI在脑卒中康复期脑网络重塑与脑可塑性中的研究进展[J]. 磁共振成像, 2025, 16(2): 135-141. DOI: 10.12015/issn.1674-8034.2025.02.022.
LI X J, YU C X, ZHAO C J, et al. Research progress of fMRI in brain network remodeling and brain plasticity during stroke rehabilitation[J]. Chin J Magn Reson Imaging, 2025, 16(2): 135-141. DOI: 10.12015/issn.1674-8034.2025.02.022.
[92]
李光硕, 赵性泉. 《中国急性缺血性卒中诊治指南2023》解读[J]. 中国卒中杂志, 2024, 19(8): 956-961. DOI: 10.3969/j.issn.1673-5765.2024.08.013.
LI G S, ZHAO X Q. Interpretation of 'Chinese guidelines for the diagnosis and treatment of acute ischemic stroke 2023'[J]. Chinese Journal of Stroke, 2024, 19(8): 956-961. DOI: 10.3969/j.issn.1673-5765.2024.08.013.
[93]
中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国缺血性卒中和短暂性脑缺血发作二级预防指南2022[J]. 中华神经科杂志, 2022, 55(10): 1071-1110. DOI: 10.3760/cma.j.cn113694-20220714-00548.
Neurology Branch of Chinese Medical Association, Cerebrovascular Disease Group of Neurology Branch of Chinese Medical Association. Guidelines for secondary prevention of ischemic stroke and transient ischemic attack in China 2022[J]. Chinese Journal of Neurology, 2022, 55(10): 1071-1110. DOI: 10.3760/cma.j.cn113694-20220714-00548.
[94]
李静, 吴泳儿, 王中秋. 基于DTI探讨针刺干预对急性缺血性脑卒中运动功能障碍的神经重塑机制[J]. 中国中西医结合影像学杂志, 2026, 24(3): 291-295, 322. DOI: 10.3969/j.issn.1672-0512.2026.03.007.
LI J, WU Y E, WANG Z Q. Neural remodeling mechanism of acupuncture intervention on motor dysfunction after acute ischemic stroke based on DTI[J]. Chinese Journal of Integrated Traditional and Western Medicine Imaging, 2026, 24(3): 291-295, 322. DOI: 10.3969/j.issn.1672-0512.2026.03.007.
[95]
朱子龙, 沈天益, 孙征, 等. 中风促通灸对脑梗死恢复期运动功能障碍患者运动功能及皮质脊髓束的影响[J]. 中国针灸, 2023, 43(12): 1358-1362. DOI: 10.13703/j.0255-2930.20230623-k0003.
ZHU Z L, SHEN T Y, SUN Z, et al. Effect of stroke-promoting moxibustion on motor function and corticospinal tract in patients with motor dysfunction during cerebral infarction recovery[J]. Chinese Acupuncture & Moxibustion, 2023, 43(12): 1358-1362. DOI: 10.13703/j.0255-2930.20230623-k0003.
[96]
李伟, 邹维志, 殷红彪, 等. 芒针透刺督脉组穴对脑卒中后痉挛性偏瘫患者皮质脊髓束重塑的影响[J]. 安徽中医药大学学报, 2026, 45(3): 60-65. DOI: 10.3969/j.issn.2095-7246.2026.03.012.
LI W, ZOU W Z, YIN H B, et al. Effect of penetrating acupuncture at Du meridian acupoints with elongated needles on corticospinal tract remodeling in patients with post-stroke spasticity[J]. Journal of Anhui Traditional Chinese Medical College, 2026, 45(3): 60-65. DOI: 10.3969/j.issn.2095-7246.2026.03.012.
[97]
REVILL K P, RIZOR E, HAUT M W, et al. Mean motor disconnectivity predicts hand function impairment after stroke: Beyond motor cortex output[J/OL]. Stroke, 2026, 57(4): 1057-1063. DOI: 10.1161/STROKEAHA.125.052559.
[98]
KHAN M, GALLAGHER L, PACKARD L, et al. Corticospinal tract injury leads to poor motor recovery immediately after ischemic stroke[J/OL]. J Neuroimaging, 2025, 35(5): e70095 [2026-02-27]. https://doi.org/10.1111/jon.70095. DOI: 10.1111/jon.70095.
[99]
许多, 郑发鑫, 江沧洲. 脑卒中后脑干华勒氏变性患者周围神经损害相关性研究[J]. 中国卫生标准管理, 2022, 13(7): 89-92. DOI: 10.3969/j.issn.1674-9316.2022.07.024.
XU D, ZHENG F X, JIANG C Z. Correlation study of peripheral nerve damage in patients with brainstem wallerian degeneration after stroke[J]. China Health Standard Management, 2022, 13(7): 89-92. DOI: 10.3969/j.issn.1674-9316.2022.07.024.
[100]
朱子龙, 沈天益, 李星星, 等. 针刺通过修复皮质脊髓束改善脑卒中后运动功能障碍的研究进展[J]. 针刺研究, 2022, 47(9): 843-846, 850. DOI: 10.13702/j.1000-0607.20210670.
ZHU Z L, SHEN T Y, LI X X, et al. Progress of researches on involvement of corticospinal tract in the effect of acupuncture on improvement of post-stroke motor dysfunction[J]. Acupuncture Research, 2022, 47(9): 843-846. DOI: 10.13702/j.1000-0607.20210670.
[101]
EDWARDSON M A, NAYAK A, IRFANOGLU M O, et al. Association between changes in white matter volume detected with diffusion tensor-based morphometry and motor recovery after stroke[J/OL]. Neurology, 2025, 104(7): e213408 [2026-02-27]. https://doi.org/10.1212/WNL.0000000000213408. DOI: 10.1212/WNL.0000000000213408.
[102]
SHEN Y, LI M, WEI R, et al. Effect of acupuncture therapy for postponing wallerian degeneration of cerebral infarction as shown by diffusion tensor imaging[J]. J Altern Complement Med, 2012, 18(12): 1154-1160. DOI: 10.1089/acm.2011.0493.
[103]
ZHAO N, ZHANG J, QIU M, et al. Scalp acupuncture plus low-frequency rTMS promotes repair of brain white matter tracts in stroke patients: A DTI study[J]. J Integr Neurosci, 2018, 17(1): 61-69. DOI: 10.31083/JIN-170043.
[104]
HAN X, BAI L, SUN C, et al. Acupuncture enhances communication between cortices with damaged white matters in poststroke motor impairment[J/OL]. Evid Based Complement Alternat Med, 2019, 2019: 4245753 [2026-02-27]. https://doi.org/10.1155/2019/4245753. DOI: 10.1155/2019/4245753.
[105]
GAO Y, LIN Z, TAO J, et al. Evidence of timing effects on acupuncture: A functional magnetic resonance imaging study[J]. Exp Ther Med, 2015, 9(1): 59-64. DOI: 10.3892/etm.2014.2056.
[106]
PARK C H, OHN S H. The predictive value of lesion and disconnectome loads for upper limb motor impairment after stroke[J]. Neurol Sci, 2022, 43(5): 3097-3104. DOI: 10.1007/s10072-021-05600-9.
[107]
PUIG J, PEDRAZA S, BLASCO G, et al. Acute damage to the posterior limb of the internal capsule on diffusion tensor tractography as an early imaging predictor of motor outcome after stroke[J]. AJNR Am J Neuroradiol, 2011, 32(5): 857-863. DOI: 10.3174/ajnr.A2400.
[108]
GAVIRIA E, ELTAYEB HAMID A H. Neuroimaging biomarkers for predicting stroke outcomes: A systematic review[J/OL]. Health Sci Rep, 2024, 7(7): e2221 [2026-02-27]. https://doi.org/10.1002/hsr2.2221. DOI: 10.1002/hsr2.2221.
[109]
URBIN M A, LIU F, MOON C H. Microstructural integrity within the damaged region of the residual corticofugal projection from primary motor cortex predicts the effect of noninvasive neuromodulation targeting the spinal cord in chronic stroke[J/OL]. Neurotherapeutics, 2025, 22(4): e00607 [2026-02-27]. https://doi.org/10.1016/j.neurot.2025.e00607. DOI: 10.1016/j.neurot.2025.e00607.
[110]
贡志刚, 付志辉, 苏昭凤, 等. 基于功能磁共振影像研究针灸治疗风痰瘀阻证中风偏瘫的疗效[J]. 现代中西医结合杂志, 2022, 31(23): 3269-3274. DOI: 10.3969/j.issn.1008-8849.2022.23.010.
GONG Z G, FU Z H, SU Z F, et al. Based on functional magnetic resonance imaging, the efficacy of acupuncture and moxibustion in the treatment of stroke hemiplegia with wind phlegm and blood stasis syndrome was studied[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2022, 31(23): 3269-3274. DOI: 10.3969/j.issn.1008-8849.2022.23.010.
[111]
KRAGULJAC N V, GUERRER M, STRICKLAND M J, et al. Neurite orientation dispersion and density imaging in psychiatric disorders: a systematic literature review and a technical note[J]. Biol Psychiatry Glob Open Sci, 2022, 3(1): 10-21. DOI: 10.1016/j.bpsgos.2021.12.012.
[112]
ALOTAIBI A, PODLASEK A, ALTOKHIS A, et al. Investigating microstructural changes in white matter in multiple sclerosis: a systematic review and meta-analysis of neurite orientation dispersion and density imaging[J/OL]. Brain Sci, 2021, 11(9): 1151 [2026-02-27]. https://doi.org/10.3390/brainsci11091151. DOI: 10.3390/brainsci11091151.
[113]
SUN F, HUANG Y, WANG J, et al. Research progress in diffusion spectrum imaging[J/OL]. Brain Sci, 2023, 13(10): 1497 [2026-02-27]. https://doi.org/10.3390/brainsci13101497. DOI: 10.3390/brainsci13101497.
[114]
PAUL T, WIEMER V M, HENSEL L, et al. Interhemispheric structural connectivity underlies motor recovery after stroke[J]. Ann Neurol, 2023, 94(4): 785-797. DOI: 10.1002/ana.26737.

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