摘要
目的为准确评估基底节区脑出血后皮质脊髓束(CST)的损伤情况和判断运动功能预后,联合运用磁共振扩散张量纤维束成像(DTT)和各向异性分数(FA)构建CST损伤类型,并探讨这种分型方法的可行性和优越性。方法将符合研究要求的18例急性基底节区脑出血患者,根据DTT图像中通过基底节区CST的类型划分为3组:(1)纤维移位型。CST未被血肿直接损伤,未被水肿区覆盖,CST轻度移位,但完整性保存。(2)水肿覆盖型。CST未被血肿直接损伤,但被血肿周围水肿区覆盖,CST完整性部分受损。(3)血肿破坏型。血肿直接破坏CST,CST完整性中断。分析3组CST损伤类型与损伤程度和运动功能预后的相关性,采用受试者操作特征曲线(ROC)检验对判断运动功能预后的准确性。结果 18例急性基底节区脑出血患者中,纤维移位型7例,水肿覆盖型6例,血肿破坏型5例。CST损伤类型与入院时MFS评分无相关性(r=-0.1254,P=0.6201),而与入院时相对各向异性分数(r FA)值、6个月后r FA值和6个月后MFS评分均存在相关性(分别为r=-0.8898,P<0.0001;r=-0.9783,P<0.0001;r=-0.8356,P<0.0001)。CST损伤类型预测运动功能预后的曲线下面积达到1.000,高于采用入院时出血量、入院时r FA值和入院时MSF评分的曲线下面积;CST损伤类型预测运动功能预后的最大截断值为0.500(敏感度100%,特异度100%)。结论 DTT联合FA划分CST损伤类型,能够定性、定量评估CST损伤状况,更准确地判断急性基底节区脑出血患者的运动功能预后。
Objective To accurately assess corticospinal tract（ CST） injury after cerebral hemorrhage in the basal ganglia and predict the motor outcome. In this study,the CST types of damage are constructed by using diffusion tensor tractography（ DTT） and fractional anisotropy（ FA）,in addition,the feasibility and superiority of this method are also discussed. Methods According to the characteristics of DTT images of CST through the basal ganglia region,patients with acute basal ganglia hemorrhage were classified into three groups： 1. Fiber distortion type where CST was neither directly injured by hematoma nor covered by edema area around the hematoma,CST is therefore mildly distorted but its integrity was preserved. 2. Edema cover type where CST was not directly injured by the hematoma,but was covered by an area of edema around the hematoma,its integrity is partially damaged. 3. Hematoma destruction type where CST was directly damaged by Hematoma,and its integrity was destroyed. The correlations between the CST types of damage with the CST degrees of damage（ r FA = affected side FA / intact side FA） and the motor outcomes were analyzed. Furthermore,the accuracy of prediction of prognosis of the motor function was tested by the ROC curve test. Results Among a tota1 of 18 patients with cerebral hemorrhage in the basal ganglia who enrolled for this study,there were 7 cases,6 cases and 5cases which respectively belonged to the Fiber distortion,Edema cover and Hematoma destruction types. There was no correlation between CSTtypes of damage and MFS scores at admission（ r =- 0. 1254,P = 0. 6201）,but the correlations were found between CST types of damage and rF A values at admission,at 6months after onset and MFS scores at 6months after onset（ r =- 0. 8898,P〈0. 0001; r =- 0. 9783,P〈0. 0001; r =- 0. 8356,P〈0. 0001; respectively）. The area under the curve of CST types of damage predicting motor function was 1. 000 ± 000,which was higher than the area under the curve of hemorrhage volume,rF A and MSF a
出处
《临床放射学杂志》
CSCD
北大核心
2016年第9期1320-1325,共6页
Journal of Clinical Radiology
基金
遵义市科技局和遵义医学院附属医院联合科技研发资金项目[遵市科合社字(2014)77号]
关键词
脑出血
基底节
扩散张量纤维束成像
各向异性分数
皮质脊髓束
Intracerebral hemorrhage
Basal ganglia
Diffusion tensor tractography
Corticspinal tract
Fractional anisotropy
