本文選題：腦出血 + 錐體束�。� 參考：《中國臨床醫(yī)學(xué)影像雜志》2015年05期

【摘要】：目的:探討彌散張量成像(DTI)評估基底節(jié)區(qū)腦出血致皮質(zhì)脊髓束(CST)損傷轉(zhuǎn)歸的可行性。方法:對36例基底節(jié)區(qū)腦出血患者于發(fā)病8~15天及4~6月內(nèi)行3.0T MR常規(guī)及DTI檢查,基于感興趣區(qū)(ROI)測量患側(cè)及對側(cè)大腦腳區(qū)的平均FA值(FA)。依據(jù)DTT圖患側(cè)CST受損程度分為A型(CST受壓移位)、B型(CST部分中斷)和C型(CST完全中斷)。比較患側(cè)及對側(cè)大腦腳區(qū)FA值的差異性,并分別比較兩次檢查患側(cè)大腦腳FA值的差異性及對側(cè)大腦腳FA值的差異。分析A型、B型及C型大腦腳區(qū)r FA值(患側(cè)FA值/對側(cè)FA值)與隨訪改良RANKIN量表(m RS)及功能獨(dú)立性評定運(yùn)動(dòng)評分(FIMm)的相關(guān)性。結(jié)果:8~15天DTI示C型m RS評分明顯差于A型及B型(t=-11.731,P0.05;t=-2.618,P0.05);A型的m RS評分優(yōu)于B型(t=-5.965,P0.05)。4~6月DTT示A型16例中2例轉(zhuǎn)化為B型,14例沒有變化。B型12例中,11例轉(zhuǎn)化為A型,1例轉(zhuǎn)化為C型;C型8例中,2例轉(zhuǎn)化為A型,1例轉(zhuǎn)化為B型,另5例沒有變化。比較兩次檢查兩側(cè)大腦腳區(qū)FA值,差異均有顯著統(tǒng)計(jì)學(xué)意義(t=-9.054,P0.05;t=-7.962,P0.05);比較兩次檢查患側(cè)大腦腳FA值,差異有統(tǒng)計(jì)學(xué)意義(t=-3.511,P0.05);比較兩次檢查對側(cè)大腦腳FA值,差異有統(tǒng)計(jì)學(xué)意義(t=-2.252,P0.05);兩次檢查大腦腳區(qū)r FA值與隨訪m RS評分有相關(guān)性(r=-0.803,P0.05;r=-0.654,P0.05),與隨訪FIMm評分均無相關(guān)性(r=0.288,P0.05;r=0.174,P0.05)。其中,第一次檢查A型大腦腳r FA值與FIMm評分弱相關(guān)性(r=0.499,P0.05);B型大腦腳r FA值與隨訪m RS評分有相關(guān)性(r=-0.875,P0.05)。第二次檢查A型大腦腳r FA值與隨訪m RS評分有相關(guān)性(r=-0.783,P0.05)。結(jié)論:在基底節(jié)腦出血中,大腦腳區(qū)r FA值能評估腦出血遠(yuǎn)期神經(jīng)運(yùn)動(dòng)功能預(yù)后,DTI成像能定量評估CST損傷轉(zhuǎn)歸及重塑。
[Abstract]:Objective: to evaluate the feasibility of diffuse Zhang Liang imaging in evaluating corticospinal tract injury caused by basal ganglia hemorrhage. Methods: 36 patients with basal ganglia intracerebral hemorrhage were examined with 3. 0T Mr routine and DTI within 815 days and 4 ~ 6 months after onset. The mean FA value (FA) of the affected and contralateral cerebral feet was measured based on ROI. According to the degree of CST damage in the affected side of DTT, there were two types: type A (compression shift of CST), type B (partial interruption of CST) and type C (complete interruption of CST). To compare the difference of FA between the affected and contralateral cerebral feet, and to compare the difference of FA between the affected and contralateral cerebral feet. To analyze the correlation between the r FA value of type A, B type and C type of cerebral foot area (FA / contralateral FA) and the modified RANKIN scale (Mrs) and the motor score (FIMM) of functional independence assessment. Results the MRS score of type C was significantly lower than that of type A and type B (tnc-11.731U, P0.05TU -2.618p0.05). The MRS score of type A was better than that of type B (tn-5.965p0.05). From April to June, DTT showed that 2 of 16 cases of type A were transformed into type B, and 11 of 12 cases of type B were transformed into type A. 11 of 12 cases of type B showed no change. Among the 8 cases of type C, 2 cases were transformed into type A and 1 case was transformed into type B. The other 5 cases had no change. There were statistically significant differences in FA values of bilateral cerebral foot regions between two examinations (tnm9.054, P0.05T- 7.962p0.05), and there were significant differences in FA values of the affected cerebral feet between the two examinations (t-3.511p0.05), and the FA values of contralateral cerebrum by two examinations (tnm9.054g, P0.0552p0.05), the difference between the two examinations was statistically significant (t-3.511p0.05), and the difference between the two examinations was statistically significant. The difference was statistically significant (t = 2.252, P 0.05), the rFA value of the cerebral foot area was correlated with the following up Mrs score (r = 0.803, P 0.05, P 0.05, P = 0.654), but had no correlation with the follow-up FIMm score (r = 0.288, P = 0.05, P = 0.174, P < 0.05). For the first time, there was a weak correlation between type A cerebral foot r FA value and FIMm score (r 0. 499U P 0.05). There was a correlation between r FA value of B type cerebral foot and follow-up Mrs score (r 0 875% P 0.05). There was a correlation between the rFA value of type A cerebral foot and the follow-up Mrs score (r = -0.783P 0.05). Conclusion: in basal ganglia hemorrhage (BGH), the rFA value of cerebral foot area can evaluate the prognosis of neurological motor function in patients with intracerebral hemorrhage. DTI imaging can quantitatively evaluate the prognosis and remodeling of CST injury.
【作者單位】： 南京醫(yī)科大學(xué)附屬南京醫(yī)院醫(yī)學(xué)影像科;南京醫(yī)科大學(xué)附屬淮安第一醫(yī)院醫(yī)學(xué)影像科;
【分類號】：R743.34;R445.2

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