DTI在中等量高血压性基底节区出血中的应用

Value of DTI in choice of treatment methods and prognosis evaluation of patients with moderate hypertensive basal ganglia hemorrhage

目的探讨磁共振弥散张量成像(DTI)在中等量(30~40 ml)高血压性基底节区出血的治疗方式选择及预后评估中的价值。方法回顾性分析2019年1月至2022年12月收治的63例中等量高血压性基底节区出血的临床资料。发病48 h内、2周行DTI检查测量测量各向异性分数(FA)并评估皮质脊髓束(CST)损伤情况,参考美国国立卫生院卒中(NIHSS)量表评分评估肢体运动功能并进行瘫痪分级(PG)。结果63例中,保守治疗25例(保守组),手术治疗38例(手术组);CST分级1级13例,2级21例,3级29例;CST分级1~2级中,保守治疗14例,手术治疗20例;CST分级3级中,保守治疗11例,手术治疗18例。发病48 h内,两组正常侧、患侧内囊区FA值均无统计学差异(P>0.05);发病2周,两组正常侧、患侧内囊区FA值均显著改善(P<0.05),而且,手术组明显优于保守组(P<0.05)。两组发病48 h患侧内囊区FA值与发病2周PG值均呈显著负相关(保守组r=-0.769,P<0.05;手术组r=-0.769,P<0.05)。CST分级1~2级病人,无论是保守治疗,还是手术治疗,发病2周PG均明显降低(P<0.05);而CST分级3级病人,只有手术治疗病人发病2周PG明显降低(P<0.05)。结论DTI技术能够准确评估中等量高血压性基底节区出血病人CST损害程度。CST损伤严重的病人,保守治疗往往预后差,早期手术清除血肿有助于CST完整性修复、改善预后。

Objective To investigate the value of magnetic resonance diffusion tensor imaging(DTI)in the treatment choice and prognosis assessment of patients with moderate(hemotoma volume,30~40 ml)hypertensive basal ganglia hemorrhage(HICH).Methods The clinical data of 63 patients with moderate HICH treated from January 2019 to December 2022 were retrospectively analyzed.Anisotropy score(FA)and corticospinal tract(CST)injury were measured by DTI images within 48 h and 2 weeks after the onset.Limb motor function was evaluated with the National Institutes of Health stroke scale(NIHSS)score and paralysis grading(PG)was calculated.Results Of these 63 patients,25 patients were treated conservatively(conservative group)and 38 were treated with surgery(operation group);13 patients suffered from CST injury Grade 1,21 from grade 2 and 29 from grade 3.Of the patients with CST injury grades 1~2,14 patients were treated conservatively and 20 were treated with surgery.Of the patients with CST injury grade 3,11 cases were treated conservatively and 18 patients were treated surgery.Within 48 h of onset,there was no significant difference in FA values between the two groups(P>0.05).Two weeks after the onset,the FA values of the internal capsular area on both the normal and hemorrhagic sides were significantly improved in both groups(P<0.05),and the FA values in the operation group were significantly better than those of the conservative group(P<0.05).There was a significant negative correlation between the FA value at 48 h and the PG value at 2 weeks(conservative group:r=-0.769,P<0.05;Operation group:r=-0.769,P<0.05).In patients with CST injury grades 1~2,PG was significantly decreased after 2 weeks of onset in both conservative and operation groups(P<0.05).In patients with CST injury grade 3,PG was significantly decreased only in the operation group(P<0.05).Conclusions DTI can accurately evaluate the degree of CST damage in patients with moderate HICH.For patients with severe CST injury,conservative treatment often has poor prognoses,and early surgical removal of hematoma is helpful to the recovery of CST and improve the patients'prognoses.