高血压壳核出血视辐射纤维损伤与视野缺损的关系

The application of magnetic resonance diffusion tensor imaging for evaluation of optic radiation injury in patients with hypertensive putaminal hemorrhage

目的采用磁共振弥散张量成像(diffusion tensor imaging,DTI)对高血压壳核出血患者的视辐射(optic radiation,OR)进行成像,探讨血肿对OR损伤情况,结合双眼视野平均缺损(mean defect,MD)值,预测患者视野缺损程度。方法纳入33例首次发病的高血压壳核出血患者作为研究对象,发病3~5 d及3个月后行DTI检查,同时纳入30例年龄、性别匹配的正常人作为对照,重建双侧OR并测定OR-FA/ADC及MD值,观察OR损伤程度(分Ⅰ、Ⅱ、Ⅲ型),对血肿体积,MD及OR-FA/ADC值行相关统计学分析。结果正常组两侧OR-FA/ADC值比较,无明显差异(P>0.05);两组MD值比较,患者组视野受损(P<0.01);患者组两侧OR-FA/ADC值比较,患侧异常(P<0.01);血肿体积与患侧OR-FA/ADC值及MD值不相关(P>0.05);MD值与患侧OR-FA/ADC值损伤程度相关(P<0.05);各OR损伤分型(3~5 d)患侧OR-FA/ADC值及MD值比较,分型越大,损伤越重(P<0.01);患者3个月后MD值及患侧OR-FA/ADC值较入院时明显改善(P<0.01)。结论 DTI可观察血肿与OR三维立体关系,直观反映OR形态变化,预测视野缺损程度。

Objective We attempted to investigate optic radiation（OR） injury and visual field mean defect（MD）in patients with hypertensive putaminal hemorrhage by using diffusion tensor imaging（DTI）. Methods Thirty-three first onset of patients with hypertensive putaminal hemorrhage and 30 normal healthy control subjects were recruited. DTI data were acquired between 3 and 5 days as well as 3 months after onset. DTI-Studio software was used to reconstruct the OR and examine the degree of OR injury（type Ⅰ,Ⅱ, and type Ⅲ）. Fractional anisotropies（FA） and apparent diffusion coefficient（ADC）values of the ORs were measured. Statistical analysis was performed to calculate hematoma volume,MD,OR-FA and ADC values by using SPSS 17.0 software. Results FA and ADC values of ORs were not significantly different between the two hemispheres in normal control groups（student t-test, P〈0.05）. Compared with MD values in control group, the visual field was significantly impaired in patients group（P〈0.01）. FA and ADC values of ORs were significantly different between two hemispheres in patient group（student t-test, P〈0.01）. There was no correlation of hematoma volume with OR-FA nor with ADC values nor with MD values（P〈0.05）. The MD values were correlated with OR-FA and ADC values after onset（P〈0.05）. MD, FA and ADC values of ORs in the affected hemisphere of the patient group were significantly different for the three OR types between 3 and 5 days as well as 3 months after onset（P〈0.01）.Conclusion DTI can examine the three-dimensional relationship between hematoma and OR, reflect the changes of OR morphology and predict the degree of visual-field defects.