弥散张量成像在高血压性脑出血后皮质脊髓束损伤中的应用研究

摘要

目的：应用弥散张量纤维束成像（DTI）观察高血压性脑出血（HICH）皮质脊髓束（CST）的损伤，探讨DTI在HICH预后评估的临床应用价值。方法对16例HICH患者（壳核8例，丘脑7例，混合型1例）患者分别于入院时（7 d内）和发病后3个月进行DTI 检查，以及肌力测定和美国国立卫生研究院卒中量表（NIHSS）评分。用平均部分各向异性（FA）和表观弥散系数（ADC）测量血肿层面周围的双侧CST，测定血肿面（患侧）／对侧面（健侧）的FA值和ADC值比率。结果 HICH患者中发病后3个月肌力较好组（肌力4～-5级）的FA值比率与肌力较差组（肌力0～3级）比较，差异有统计学意义。而ADC比值在入院时及发病后3个月都没有差别。所有FA值比率＞0．8患者的运动功能都有改善和预后好。然而有1例患者虽然FA值比率不是很高，但运动功能的预后也很好，其ADC值明显升高。 CST完整的患者入院时和发病后3个月的肌力和NIHSS评分均比CST中断的患者好，发病后3个月是恢复最快的阶段。结论通过DTI的FA值比率可以了解基底核区HICH患者CST的损伤情况，有助于早期预测神经功能的恢复情况和指导治疗方案的制定。%Objective We prospectively investigated the predictive value of diffusion tensor imaging ( DTI ) for motor functional outcome in a case series of patients with hypertensive intracerebral hemorrhage ( HICH ) .Methods DTI was performed in 16 patients with intracerebral hemorrhage ( 8 putamen , 7 thalamus and 1 mixed type ) within one week after onset . Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values along the corticospinal tracts at the level of the hematoma were measured bilaterally , and the ratios of values ( hematoma side/contralateral side ) were determined as FA and ADC ratios , respectively . Patients were evaluated for motor function on admission and at 3 months after onset using the manual muscle test ( MMT ) score and then divided into good ( MMT, 4-5 ) and poor ( MMT, 0-3 ) motor function groups , which evaluated by the NIHSS .Results FA ratio measured shortly after the onset of intracerebral hemorrhage correlated well with motor functional outcome at 3 months ( P<0 .05 ) , but not with motor function on admission .FA ratios in the group with good motor functional outcome were significantly higher than those in the group with good motor functional outcome were significantly higher than those in the group with poor motor functional outcome (P<0.01).The ADC ratio did not correlate with motor function either on admission or at 3 months.All patients who showed higher than 0.8 FA ratios had a good motor functional outcome .In one patient, however,motor functional outcome was favorable even though FA ratios were not high;in these patients , ADC ratios tended to be elevated .Conclusion Motor functional outcome in patients with intracerebral hemorrhage can be predicted by measuring FA values using diffusion tensor imaging .