DTI对高血压性基底节区出血病人皮质脊髓束损伤程度评估的价值

Evaluation of the effect of cerebral hemorrhage in basal ganglia on the severity of corticospinal tract injury by MR diffusion tensor imaging

目的探讨磁共振弥散张量成像(DTI)在高血压性基底节区出血病人皮质脊髓束(CST)损伤程度评估中的价值。方法选择2015年2月～2016年2月收治的高血压性基底节区出血90例,根据治疗方法分为手术组(48例,采用神经导航辅助下血肿清除术治疗)和保守组(42例,采用保守治疗);手术组又按CST损伤情况分为手术A组(CST损伤分级1～2级,26例)和手术B组(CST损伤分级3～4级,22例)两个亚组。发病48 h、14 d,进行DTI检查,同时采用美国国立卫生院卒中量表评分进行瘫痪分级(PG)。结果发病48 h,手术组和保守组双侧大脑脚、内囊区各向异性(FA)值无显著差异(P>0.05),CST损伤分级无统计学差异(P>0.05)。发病14 d,手术组和保守组患侧大脑脚、内囊区FA值均显著低于患侧(P<0.05),但手术组明显高于保守组(P<0.05);手术组和保守组CST损伤分级均显著优于发病48 h(P<0.05),而且手术组明显优于保守组(P<0.05)。发病48 h,手术A、B两亚组内囊区FA值无显著性差异(P>0.05),PG也无统计学差异(P>0.05);发病14 d,手术A组患侧内囊区FA值显著高于手术B组(P<0.05),但PG显著低于手术B组(P<0.05)。结论 DTI能准确评价高血压性基底节区出血病人CST损伤程度及范围。

Objective To investigate the evaluation of the effect of cerebral hemorrhage in basal ganglia on the severity of corticospinal tract(CST) injury by MR diffusion tensor imaging(DTI). Methods Of 90 patients with cerebral hemorrhage in basal ganglia treated in the Central Hospital of Xuhui District from February, 2015 to February, 2016, 42(control group) were conservatively treated and 48(observed group) were treated with neuronavigator-assisted of evacuation hematomas, of whom, 26 had intact CST(group A) and2 incomplete CST(group B) according to intraoperative observation. The diffusion tensor tractography(DTT), fractional anisotropy(FA)and paralysis grading(PG) of bilateral CST were compared between both in the sides. Results The FA values of the healthy side cerebral peduncle and internal capsule area were significantly higher than those of the affected side ones 48 hours and 14 days after the cerebral hemorrhage in all the groups(P<0.05). FA values of the cerebral peduncle and internal capsule area on the affected side the observed group were higher than those in the control group. The FA value of the internal capsule area on the affected side was significantly higher in group A than that in group B(P<0.05). PG scores were significantly higher in the observed group than those in the control group 48 hours and 14 days after the hemorrhage. The PG scores were significantly higher in group A than those in group B(P<0.05). The recovery of injured CST was significantly better in the observed group than that in the control group(P<0.05). Conclusion DTI can be used to accurately evaluate the degree and extent of CST injury in patients with cerebral hemorrhage. The curative effect of neuronavigatorassisted evaluation hematoma on the injured CST is better than that in conventional conservative treatment in the patients with moderate to small amount of cerebral hemorrhage in basal ganglia.