[1]孙伟,钱忠心,刘卫东.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[J].临床神经外科杂志,2015,(03):230-234.
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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()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
期数:
2015年03期
页码:
230-234
栏目:
论著
出版日期:
2015-06-15

文章信息/Info

Title:
Applied study on diffusion tensor imaging in the corticospinal tract injury after the hypertensive intracerebral hemorrhage
作者:
孙伟 钱忠心 刘卫东
上海市浦东新区浦南医院
关键词:
高血压脑出血弥散张量纤维束成像皮质脊髓束
Keywords:
intracerebral hemorrhage diffusion tensor imaging corticospinal tract
分类号:
R651.1
文献标志码:
A
摘要:
目的 应用弥散张量纤维束成像(DTI)技术观察高血压性脑出血(HICH)皮质脊髓束(CST)的受损情况,前瞻性的探讨弥散张量纤维束成像技术在HICH预后评估的临床应用价值。方法 对16例高血压脑出血患者(8例是壳核,7例丘脑,1例是混合型)。平均部分各项异性(FA)和表观弥散系数(ADC)被用来测量血肿层面周围的皮质脊髓束(CST),双侧均被检测。通过血肿面(患侧)/对侧面(健侧)的FA值和ADC值进行值比率测定。,所有患者分别于入院时即刻(一周之内)后和发病3个月进行DTI检查,并进行肌力测定和NIHSS评分。 结果 高血压性脑出血的患者的FA值比率测定比较:入院时肌力比较无差异,但3月后运动功能改善有差异。肌力较好组(肌力3-5级)的FA值比率和肌力较差组(肌力0-2级)的FA差异显著。然而ADC比值无论是在入院即刻还是3个月都没有差别。所有患者的FA值比率大于0.8的运动功能都有好的预后和改善。然而有一个患者虽然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。健侧CST解剖形态与正常人大致相吻合,患侧CST则受血肿的侵犯表现为受压移位不同程度的破坏,CST完整患者的肌力和NIHSS评分在各个时期均较CST中断的患者好,发病后3个月是恢复最快的阶段。 结论 通过弥散张量纤维束成像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。
Abstract:
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 (putamen, eight patients; thalamus, seven patients; combined, one patient) 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 with an FA ratio greater than 0.8 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.

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备注/Memo

备注/Memo:
[收稿日期] 2015-01-04 基金项目:上海市浦东新区卫生系统优秀青年医学人才培养(PWRq2013-13);上海市卫生局医学重点专科建设项目资助(ZK2012A31)
更新日期/Last Update: 2015-06-15