利用弥散张量成像评估中小量基底节区高血压脑出血微创手术的治疗效果.doc

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1、利用弥散张量成像评估中小量基底节区高血压脑出血微创手术的治疗效果蒋永祥，马颖，程远▲,陈维福(重庆医科大学附属第二医院神经外科，重庆400010)提要：目的利用弥散张量成像(diffusiontensorimaging,DTI)评估中小量基底节区高血压脑出血的微创治疗效果。方法以101例中小量基底节区高血压脑出血患者为对象，随机分为微创手术组和内科治疗组。所有患者在发病后48小时内和发病后14天进行DTI扫描，得到双侧皮质脊髓束(corticospinaltract,CST)的各向异性分数(fractionalanisotropy,FA)及弥散张量纤维束成像(Diffu

2、siontensortractography,DTT)图像，并根据CST完整性将微创手术组分为A、B两个亚组，比较各组之间的差异。结果发病后首次DTI扫描显示微创手术组、内科治疗组受累侧的内囊区和大脑脚FA值均降低，但两组间无明显差异，第二次DTI扫描显示微创手术组的FA值较内科治疗组明显升高。微创手术组的A亚组术后FA值高于B亚组。另外，从DTT图像上可观察到微创手术组的CST恢复程度明显好于内科治疗组。结论DTI可以准确评估和预测中小量基底节区高血压脑出血的运动功能预后；对于这类患者，尤其是DTT显示CST以推移、变形为主者应更为积极的采取微创治疗以提高运动功能预后

3、。关键词：高血压脑出血；基底节区；微创治疗技术；弥散张量成像；各向异性中图法分类号：R743.34Evaluateeffectsofminimallyinvasivetechniquesforevacuationofsmalltomediumhematomainpatientswithhypertensiveintracerebralhemorrhageinbasalganglia:observedbydiffusiontensorimagingJIANGYong-Xiang,MAYing,CHENGYuanA,CHENWei-Fu(DepartmentofNeuros

4、urgery,theSecondAffiliatedHospitalofChongQingMedicalUniversity,Chongqing400010,China)Abstract:ObjectiveToevaluatetheeffectofminimallyinvasiveevacuationofsmalltomediumhypertensiveintracerebralhemorrhage(ICH)inbasalgangliabydiffusiontensorimaging(DTI).Methods101patientswithsmalltomediumhyp

5、ertensiveICHinbasalgangliawereselectedanddividedintoaminimallyinvasivetreatmentgroup(52patients)andamedicaltreatmentgroup(49patients)randomly:thevolumeofhematomawas15-36ml(theaveragevolumewas23.36±7.242ml).AllpatientsproformedDTIscanwithin48hoursand14daysafteronset,thefractionalanisotrop

6、y(FA)andthediffusiontensortractography(DTT)ofcorticospinaltract(CST)intheaffectedandunaffectedsidewereobtained.Theminimallyinvasivetreatmentgroupwasdividedintotwosub-group(AandB)accordingtotheintegrityofCST,1-2gradewasmostlyinAsub-groupand3gradewasmostlyinBsub-group.Thedatawerecomparedbe

7、tweenminimallyinvasivetreatmentgroupandmedicaltreatmentgroup,andalsobetweenAsub-groupandBsub-group.ResultsTheinitialDTIscanningshowedthatFAvaluesofCSTininternalcapsuleandcerebralpeduncleofaffectedsideweresignificantlydecreasedascomparedwiththeunaffectedside,therewerenotsi