磁共振弥散张量成像在高血压脑出血微创手术及预后评估中的应用

Application of DTI in the evaluation of therapeutic efficiency and prognosis for hypertensive intracerebral hemorrhage with minimally invasive surgery

目的探讨弥散张量成像(DTI)及弥散张量纤维束成像(DTT)在高血压脑出血(HICH)微创手术疗效及预后评估中的应用价值。方法选取收住的HICH病人40例,根据治疗方式不同随机分成内科治疗组与微创手术组各20例,分别于发病24 h内及发病后30 d行DTI扫描,得到双侧皮质脊髓束(CST)各向异性分数(FA值)及弥散张量纤维束成像(DTT)。根据2组患者治疗前后患侧内囊区的FA值变化及DTT图像所显示CST的完整性,并结合受累肢体运动能力的变化,评测微创手术治疗HICH的有效性及早期行DTI扫描对其预后评估的应用价值。结果微创手术组与内科治疗组发病24 h内患侧内囊区FA值无明显差异(P>0.05)。发病后30 d微创手术组FA值明显高于内科治疗组,差异有统计学意义(P<0.05)。治疗后DTT图像显示微创手术组CST显影较内科治疗组好,且CST较完整的病人对侧肢体肌力恢复较好,均达4级以上。结论对出血量为30~40 m L的基底节区HICH,我们应积极微创手术治疗。发病早期行DTI扫描及DTT成像观察CST损伤程度可以客观地预测患者肢体运动功能的预后。

Objective To explore the application value of diffusion tensor imaging （DTI） and diffusion tensor tractogrphy （DTT） in minimally invasive surgery of hypertensive intracerebral hemorrhage （HICH）. Methods 40 patients with HICH were select- ed. All patients were randomly divided into medical treatment group and minimally invasive surgery group according to treatment （n = 20）. Everyone received DTI scanning within 24h after intracerebral hemorrhage and in 30 d after onset, and fractional anisotropy （FA）and DrlqTM of bilateral CST were obtained. Compared the FA value and the integrity of the CST before and after treatment, and combined the motor ability of the affected limb to evaluate the effectiveness of minimally invasive surgery in the HICH and the value of DTI scan in the early stage of HICH. Results There was no significantly difference in the FA within 24 h （P 〉 0.05 ）. The FA value of medical treat- ment group was higher than that in medical treatment group in the 30th after the onset （ P 〈 0.05）. After treatment, the DTT images showed that the CST fiber bundle developed in the minimally invasive surgery group was better than that of the medical treatment group, and the more complete in the CST,the better the recovery of patient＇s limb muscle strength. Conclusion It should be actively adopted minimally invasive surgery for patients with HICH in the basal ganglia region between 30 -40 mL. In the early stage of the disease, we can observe the degree of CST damage by DTI and DTT to objectively predict the prognosis of patients with limb motor function.