功能磁共振影像低频振幅对自发性脑出血微创血肿清除术后患者预后的评估价值

Prognostic Value of Amplitude of Low-frequency Fluctuation in Functional Magnetic Resonance Imaging on Assessing the Prognosis of Patients After Minimally Invasive Hematoma Removal for Spontaneous Cerebral Hemorrhage

探讨脑活动低频振幅(ALFF)在脑出血患者微创手术恢复后运动功能方面的临床预测价值.选取脑出血患者术前静息态功能磁共振影像及结构像检查的21例患者.经脑出血微创手术随访结果分为Rankin评分高组(定义为恢复好组)10例及Rankin评分低组11例.在术后7 d与术后6个月时分别对21例患者进行Rankin量表检查.采用配对样本t检验,比较术后7 d与术后6个月患者Rankin评分减分率.影像学分析中,在0.01~0.1 Hz的频带上取振幅的平均值,作为给定体素的ALFF并对每个体素的ALFF通过除以全脑ALFF平均值,对有统计学意义的参数值做受试者工作特征(ROC)曲线,分别计算敏感度、特异度及曲线下面积(AUC).通过对减分率高的组进行分析,发现辅助运动区(Supplementary Motor Area)、初级视觉皮层(Primary Visual Cortex)在Rankin高分组与Rankin低分组差异有统计学意义(p<0.01).ROC曲线分析,Rankin对患者术后初级视觉皮层与辅助运动区的AUC分别为0.91,0.82;p值分别为0.01与0.002.本研究提示患者辅助运动区和初级视觉皮层活动对于术后运动相关高级认知功能的恢复有重要作用.

The clinical predictive value of low frequency amplitude of brain activity(ALFF)in motor function after recovery from minimally invasive surgery in patients with cerebral hemorrhage was investigated in this study.Twenty-one patients with cerebral hemorrhage who had preoperative resting-state functional magnetic resonance imaging and structural imaging were selected.The results of minimally invasive surgery for cerebral hemorrhage were divided into 10 cases in the high Rankin score group(defined as the good recovery group)and 11 cases in the low Rankin score group.Twenty-one patients were postoperatively examined with Rankin scale after 7 days and 6 months of operations.Paired sample t-test was used to compare the reduction rate of Rankin score between 7 days and 6 months after operation.For imaging analysis,the average of amplitudes in the frequency band from 0.01 to 0.1 Hz was taken as the ALFF for a given voxel,and the ALFF for each voxel was made by dividing the whole-brain ALFF means by the statistically significant parameter values for the subject work characteristic(ROC)curve,so that the sensitivity,specificity and area under the curve(AUC)were calculated,respectively.The analysis of the group with a high rate of subtraction revealed statistically significant differences(p<0.01)in the Supplementary Motor Area and Primary Visual Cortex between the high Rankin group and the low Rankin group.AUC for postoperative primary visual cortex and supplementary motor areas were 0.91 and 0.82,respectively;p-values were 0.01 and 0.002,respectively.The study suggested that the activities of the patients'supplementary motor area and primary visual cortex played an important role in the recovery of motor-related advanced cognitive functions after surgery.