弥散张量纤维束成像在高血压性脑出血患者神经功能恢复评估中的应用研究

Primary study on diffusion tensor tracking in assessing of prognosis of neurofunction recovery for patients with hypertensive intracerebral hemorrhage

目的:应用弥散张量纤维束成像(DTT)技术观察基底核区高血压性脑出血(HICH)皮质脊髓束(CST)的受损情况,探讨弥散张量纤维束成像技术在HICH预后评估的临床应用价值。方法:对18例基底核区HICH患者进行磁共振弥散张量成像检查,所有患者分别于入院时、发病后第3个月、第6个月进行肌力测定、NIHSS评分,对CST损伤程度和各个时期肌力、NIHSS评分的关系进行分析。结果:健侧CST解剖形态与正常人大致相吻合,患侧CST则受血肿的侵犯,表现为受压、移位、不同程度的破坏;CST完整患者的肌力、NIHSS评分恢复情况在各个时期均较CST中断的患者好,发病后3个月是恢复最快的阶段。结论:通过弥散张量纤维束成像可以了解基底核区HICH患者CST的损伤情况,有助于早期预测神经功能的恢复情况,指导治疗方案的制定。

Objective：To study the impairment severity of cortical spinal tract（CST） of 18 cases with hypertensive intracerebral hemorrhage（HICH） in basal ganglion region by using diffusion tensor tracking（DTT）,and to evaluate the clinical value of DTT in assessing the recovery and prognosis of HICH.Method：Eighteen patients with HICH in basal ganglion region were performed duffusion tensor imaging（DTI） using GE sina exite imaging system.American national institutes of health stroke assessment（NIHSS） scores were used for assessment of nerve function injury and the muscle strength were assessed at admission,and the 3rd month,the 6th month after attack of HICH.The relationship between the impairment severity of CST and the level of nerve function in various periods was analyzed.Result：The CST of healthy side showed on DTT was well consistent with known anatomic features,however the CST of affected side was compressed,displaced and broken.The recovery of muscle strength and NIHSS score of patients with intact CST at different periods were better than those in patients with interrupted CST.Three months after attack was the fastest stage of neurological function recovery.Conclusion：For patients with HICH in basal ganglion region,the impairment severity of CST could be evaluated by using DTI,and it was helpful for clinicians to judge the recovery and prognosis of neurological function and to formulate the treatment scheme.