摘要
目的探讨扩散张量成像（DTI）评估基底节区脑出血致皮质脊髓束（CST）损伤及运动功能预后的可行性。方法对30例基底节区脑出血患者于发病8一15天内行3．0TMR常规及DTI检查，基于感兴趣区测量患侧及对侧放射冠、内囊后肢及大脑脚区的平均各向异性分数（FA）值。依据扩散张量纤维示踪成像（DTT）图患侧CST受损程度分为A组（CST未破坏组）和B组（CST破坏组）。比较两组放射冠、内囊后肢、大脑脚区rFA值（患侧FA值／对侧FA值）及入院美国国立卫生研究院卒中量表（NIHSS）、随访改良Rankin量表（mRS）、随访英国医学研究理事会肌力（MRC）评分的差异。分析不同部位rFA值与人院NIHSS、随访mRS及随访MRC评分的相关性。结果共30例基底节脑出血患者，DTI显示CST受压移位者18例（A组），部分破坏者12例（B组），比较两组患者内囊后肢、大脑脚区rFA值、血肿体积、入院NIHSS评分、随访mRS评分、随访MRC_上肢评分及MRC_下肢评分，差异均有显著统计学意义（P〈0．05）。内囊后肢及大脑脚区rFA值与入院NIHSS、随访mRS、MRC_上肢及MRC_下肢评分均有相关性（P〈0．05）。大脑脚区rFA值评估神经运动功能预后的曲线下面积（0．810±0．083）大于内囊后肢rFA值的曲线下面积（0．757±0．093）。大脑脚区rFA值基于mRS评分评估神经运动功能预后的最佳截断值为0．851（敏感性为76．2％，特异性为77．8％）。结论在基底节脑出血中，DTI成像能定量评估CST损害的微细结构变化，大脑脚区rFA值较放射冠及内囊后肢更能评估脑出血远期神经运动功能预后。
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 intracerebral hemorrhage in basal ganglia. Methods Thirty patients with intracerebral hemorrhage in basal ganglia underwent routine MR sequences and diffusion tensor imaging sequence in the period of 8 to 15 days after onset on 3.0T MR unit. A region of interest based analysis was performed for mean value of fractional anisotropy （FA） within the corona radiate, internal capsule and cerebral peduncle. According to the extent of the CST damage on DTI＇ maps, group A （ CST undestroyed） and group B （ CST destroyed） were classified. The ratios of FA values in the affected and unaffected hemisphere （rFA） within the corona radiata, internal capsule and cerebral peduncle and National Institute of Health stroke scale （NIHSS） scores when admission, modified Rankin Scale （mRS） scores and the UK Medical Research Council （MRC） scores at 2 -6 months after onset were compared be- tween the two groups. The correlations of rFA with NIHSS scores when admission and mRS scores and the MRC scores at 2 -6 months after onset were analysed. Results Among thirty patients with intracerebral hemorrhage in basal ganglia, there were 18 patients with distortion of CST around hematomas （group A） and 12 patients with disruption of CST （group B）. There was statistically significant difference（P 〈 0.01 ） in rFA values from the internal capsule and the cerebral peduncle, NIHSS scores when admission, mRS and MRC scores of both upper and lower limbs at 2 - 6 months after onset between the two groups, rFA values from the internal capsule and the cerebral peduncle were correlated with NIHSS scores when admission, mRS and MRC scores of both upper and lower limbs at 2 - 6 months after onset （ P 〈 0.05 ）. The area un- der receiver operating characteristic curve （ROC） of rFA values from the cerebral peduncle （0. 810 _＋0. 083） for predicting neurological motor function outcome was slight greater than that from the internal capsule （0. 757 ~ O. 093 ）. The cutoff point of the rFA for predicting neurological motor function outcome by mRS was set at 0. 851 with the sensitivity 76.2% and the specificity 77.8%. Conclusion Of the iutracerebral hemorrhage in basal ganglia, DT＇I＇ parameters may quantitatively evaluate the microscopic changes of CST damage, rFA values from the cerebral peduncle more accurately predict long term neurological motor function outcome compared with those from the corona radiata and the internal capsule.
出处
《临床放射学杂志》
CSCD
北大核心
2014年第3期320-324,共5页
Journal of Clinical Radiology
基金
南京市卫生局十二.五规划重大项目
南京市科技局面上项目(编号:201201075)
关键词
脑出血
基底节
扩散张量成像
皮质脊髓束
Intracerebral hemorrhage
Basal ganglia
Diffusion tensor imaging
Corticspinal tract
