弥散张量成像对高血压脑出血患者运动功能的预测价值

Predictive value of diffusion tensor imaging for motor functional outcome in patients with hypertensive intracerebral hemorrhage

目的探讨弥散张量成像(DTI)对高血压脑出血(HICH)患者运动功能的预测价值。方法选取2017年1月至2018年7月在绍兴市人民医院住院且采取保守治疗的HICH患者22例,分别在发病后10~14 d、6个月行DTI检查,测量大脑脚、内囊后肢、胼胝体部分各向异性值(FA),计算患侧FA/健侧FA比值(rFA),同时进行皮质脊髓束(CST)损伤分级。采用美国国立卫生研究院卒中量表(NIHSS)评估患者发病后6个月的运动功能。分析rFA与运动功能的关系,以及rFA对运动功能的预测效能。结果发病后10~14 d、6个月患侧大脑脚、内囊后肢FA较健侧均明显降低(均P<0.05)。CST 1~2级患者大脑脚、内囊后肢rFA均高于3~4级患者(P<0.05),而NHISS低于3~4级患者(P<0.05)。发病后6个月患侧胼胝体体部FA明显高于发病后10~14 d(P<0.05);但不同时点胼胝体膝部及压部FA比较,差异均无统计学意义(均P>0.05)。发病后10~14 d患侧大脑脚、内囊后肢rFA与6个月NHISS均呈负相关(r=-0.486、-0.719,均P<0.05)。发病10~14 d患侧大脑脚rFA预测6个月运动功能的AUC为0.78,最佳截断值为0.85,灵敏度为0.57,特异度为1.00;发病10~14 d患侧内囊后肢rFA预测6个月运动功能的AUC为0.80,最佳截断值为0.73,灵敏度为0.64,特异度为0.87。结论DTI能直观地显示HICH患者CST受损程度并进行量化,且发病后10~14 d大脑脚及内囊后肢rFA可用于运动功能的预测,其中内囊后肢rFA的预测效能更好。

Objective To investigate the value of diffusion tensor imaging(DTI) in the prediction of motor functional outcome in patients with hyperten s ive intracerebral hemorrhage(HIC H).Methods Twenty-two patients with HICH who underwent conservative treatment in Shaoxing People’s Hospital from January 2017 to July 2018 were recruited in our study.DTI was performed at the time of 10-14thD and 6thM after the onset.The fractional anisotropy(FA) value of bilateral cerebral peduncles,bilateral internal capsule and callosum were analyzed.The ratio of FA values(rFA) between affected and unaffected site was calculated and CST was graded.The motor functional outcome was evaluated using the national ins titutes of health stroke scale(NIHSS) at 6th.The correlation between rFA and motor outcome was analyzed,and the prediction value of rFA in motor outcome was estimated in the study.Results The FA of cerebral peduncles and internal capsule at 10-14thD and 6thM were significantly decreased at the affe cted side(P<0.05).The rFA of cerebral peduncles and internal capsule in CST 1-2 group were higher than that in CST 3-4 group(P<0.05),while NHISS in CST 1-2 group was lower than that in CST 3-4 group(P<0.05).The FA of internal capsule body at 6thM was higher than that at 10-14thD(P<0.05),however,the FA in genu of corpus callosum and splenium of corpus callosum showed no difference between 10-14thD and 6thM(P>0.05).Both of the rFA of cerebral peduncles and internal capsule at 10-14thD were negatively correlated with NHISS score at 6thM(r=-0.486,-0.719,P<0.05).The AUC of rFA of cerebral peduncles at 10-14thD was 0.78.Taking rFA=0.85 as cutoff point,the sensitivity and specificity was 0.57 and 1.00,respectively.The AUC of rFA of corpus callosum at 10-14thD was 0.80,taking rFA=0.73 as cutoff point,the sensitivity of 0.64 and the specificity of 0.87.Conclusion DTI can d irectly reflect and grade the damage degree of CST.The rFA in both of internal capsule and cerebral peduncles at 10-14thD can be used to predict motor outcome.Moreover,the prediction value of rFA in internal cap sule at 10-14thD performs better.