摘要
目的：探讨弥散张量成像（DTI）评估基底节区脑出血致皮质脊髓束（CST）损伤转归的可行性。方法：对36例基底节区脑出血患者于发病8~15天及4~6月内行3.0T MR常规及DTI检查，基于感兴趣区（ROI）测量患侧及对侧大脑脚区的平均FA值（FA）。依据DTT图患侧CST受损程度分为A型（CST受压移位）、B型（CST部分中断）和C型（CST完全中断）。比较患侧及对侧大脑脚区FA值的差异性，并分别比较两次检查患侧大脑脚FA值的差异性及对侧大脑脚FA值的差异。分析A型、B型及C型大脑脚区rFA值（患侧FA值/对侧FA值）与随访改良RANKIN量表（mRS）及功能独立性评定运动评分（FIMm）的相关性。结果：8~15天DTI示C型mRS评分明显差于A型及B型（t=-11.731，P＜0.05；t=-2.618，P＜0.05）；A型的mRS评分优于B型（t=-5.965，P＜0.05）。4~6月DTT示A型16例中2例转化为B型，14例没有变化。B型12例中，11例转化为A型，1例转化为C型；C型8例中，2例转化为A型，1例转化为B型，另5例没有变化。比较两次检查两侧大脑脚区FA值，差异均有显著统计学意义（t=-9.054，P＜0.05；t=-7.962，P＜0.05）；比较两次检查患侧大脑脚FA值，差异有统计学意义（t=-3.511，P＜0.05）；比较两次检查对侧大脑脚FA值，差异有统计学意义（t＝-2.252，P＜0.05）；两次检查大脑脚区rFA值与随访mRS评分有相关性（r＝-0.803，P＜0.05；r＝-0.654，P＜0.05），与随访FIMm评分均无相关性（r＝0.288，P＞0.05；r＝0.174，P＞0.05）。其中，第一次检查A型大脑脚rFA值与FIMm评分弱相关性（r＝0.499，P＜0.05）；B型大脑脚rFA值与随访mRS评分有相关性（r＝-0.875，P＜0.05）。第二次检查A型大脑脚rFA值与随访mRS评分有相关性（r＝-0.783，P＜0.05）。结论：在基底节脑出血中，大脑脚区rFA值能评估脑出血远期神经运动功能预后，DTI成像能定量评估CST损伤转归及重塑。
Abstract
Objective: To evaluate the role of diffusion tensor imaging(DTI) in evaluating the corticspinal tract(CST) damage and predicting neurological motor function outcome for patients with basal ganglia hemorrhage. Methods: Thirty-six patients with intracerebral hemorrhage in basal ganglia underwent 3.0T MR scanning with routine sequences and DTI sequence in the period of 8 to 15 days and 4 to 6 months after onset. A region-of-interest-based analysis was performed for mean FA values within the cerebral peduncle. According to the extent of the CST damage on DTT maps, group A(CST undestroyed), group B(CST was interrupted around the hematoma) and group C(CST did not reach the hematoma) were classified. The ratios of FA values in the affected and unaffected hemisphere(rFA) within the cerebral peduncle were compared between the two groups and two examinations(the first time and follow-up examinations). The correlations of rFA with modified Rankin Scale (mRS) scores and the motor component of the functional independence measure(FIMm) at 4~6 months after onset were analysed. Results: In the period of 8 to 15 days, the motor function of type C was worse than that of type A or B(P<0.05), and motor function of type A was better than that of type C(P<0.05). In the period of 4 to 6 months, of 16 type A, only 2 changed to type B; of 12 type B, 11 changed to type A and 1 changed to type C; of 8 type C, 2 changed to type A, 1 changed to type B and 5 remained the same. There was statistically significant difference(P<0.05) in FA values between the affected and unaffected cerebral peduncle at two DTTs. There was statistically significant difference in FA values of the affected between the two examinations(P<0.05) and unaffected cerebral peduncle between the two examinations(P<0.05). The rFA values from the cerebral peduncle were correlated with mRS scores(P<0.05), but not correlated with FIMm scores at two DTTs. At the first DTT, a weak correlation was revealed between rFA and FIMm scores in group A(P＜0.05) and a strong correlation between rFA and FIMm scores in group B(P＜0.05). At the second DTT, strong correlation was revealed between rFA and mRS scores in group A(P＜0.05). Conclusions: For basal ganglia hemorrhage, rFA values from the cerebral peduncle could predict long-term neurological motor function outcome and CST damage.
关键词
脑出血 /
锥体束 /
磁共振成像 /
弥散
Key words
Cerebral hemorrhage /
Pyramidal tracts /
Diffusion magnetic resonance imaging
陈庆华;徐青青;殷信道.
弥散张量成像对基底节区脑出血致皮质脊髓束损伤转归评估[J]. 中国临床医学影像杂志. 2015, 26(5): 309-312
CHEN Qing-hua;XU Qing-qing;YIN Xin-dao.
Role of diffusion tensor imaging in evaluating corticspinal tract damage outcome for patients with basal ganglia hemorrhage[J]. Journal of China Clinic Medical Imaging. 2015, 26(5): 309-312
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