磁共振动态弥散张量成像对基底节急性脑出血中长期运动功能评估

目的探讨弥散张量成像(Diffusion Tensor Imaging,DTI)预测急性基底节区脑出血(Basal Nuclei cerebralHemorrhage BNCH)后远期运动障碍程度及预后的可行性。方法收集26例首次发病急性BNCH伴有偏瘫体征的病例,分别在发病后3天及2周基于感兴趣区大脑脚锥体束解剖学区域测定各向异性值(Fractional Anisotropy,FA),运动障碍采用美国国立卫生研究所卒中量表(National Institute ofHealth Stroke Scale,NIHSS)的偏瘫分级(Paresis Grading,PG),并分别在入院时及发病后1年的随访时间范围内评定,最后一次随访时评测功能预后(modified Rankin Scale,mRS)。结果受累侧的3天内FA值和2周FA值均明显低于未受累侧(均P<0.01),而同时平均弥散值两侧均没有变化(P>0.05)。2周受累侧和未受累侧的FA比值(Ratio of the FA,rFA),较3天rFA值,与末次PG值、末次NIHSS、末次mRS的相关性更为显著均(P<0.01)。以预测脑卒中后长期运动预后是否良好为目标时,2周rFA值受试者操作特性曲线(ROC)下面积(0.79)大于3天rFA值的ROC下面积(0.77),预测运动预后的2周rFA最佳届值为0.88(敏感度76%,特异度89%)。结论在3天至2周的急性期DTI的改变可以量化评价远期的运动缺损程度、总体预后和功能结局。2周的DTI数据与3天的DTI数据相比更有效的预测基底节区急性脑出血患者的远期总体预后、生活自理能力。

Evaluation of Long-Term motor function in Acute basal nuclei cerebral Hemorrhage Using Dynamic Diffusion Tenseor Imaging

Objective The aim of this study was to quantify and predict the long-term neuromotor outcome of patients with basal nu- clei cerebral Hemorrhage by using Dynamic diffusion tensor imaging （DTI） in the acute phase. Methods Twenty seven patients with a hemiparetic basal nuclei Intracranial Hemorrhage were prospectively studied with DTI within about 3 days and 2 weeks after onset respectively. A region-of-interest-based analysis was performed for the fractional anisotropy （FA） of the CST in the cerebral pedun- cles. The degree of paresis was assessed at day 0 and more than 6 months in following by paresis grading （PC,）. The functional out- come was evaluated by the modified Rankin Scale （mRS）. Results Compared with that of the unaffected side, the twice FA in the af- fected side at day 3 and the end of following were significantly lower （P 〈 0. 001 ） with the mean diffusivity remaining unchanged （P = 0.05 and P = 0.136, respectively）. The ratio of the FA （rFA） in the affected side to the unaffected side at 2 weeks was signifi- candy correlated with the PG and the mRS score at the end of following （P 〈 0. 091, r = -0. 700; P 〈 0.001, r = -0.653）. The area under receiver operating characteristic curve （ROC） of rFA at 2 weeks for the good and poor outcomes based on the PC, was greater than the area under ROC of rFA at day 3. The cutoff point of the rFA at 2 weeks for the good and poor outcomes was set at 0. 875 （sensitivity is 76%, specificity is 89% ）. Conclusions We conclude that DTI can evaluate the motor deficit quantitatively and may predict the functional outcome in patients with an BNCH who were in acute phase after the ICH onset. Compared with day 3, DTI at 2 weeks predict effectivly the longterm outcome of daily living in patients with basal nuclei Intracranial Hemorrhage.