Study On Prognosis And Evaluation Of Patients With Hypertensive Intracerebral Hemorrhage In Basal Ganglia: Application Of Diffusion Tensor Imaging

Part one: Evaluate effects of minimally invasive techniques forevacuation of small to medium hematoma in patients with hypertensiveintracerebral hemorrhage in basal ganglia: observed by diffusiontensor imagingObjective: To evaluate the effect of minimally invasive evacuationof small to medium hypertensive intracerebral hemorrhage (HICH) in basalganglia by diffusion tensor imaging (DTI).Methods:101patients with small to medium HICH in basal gangliawere selected and divided into a minimally invasive treatment group (52patients) and a medical treatment group (49patients): the volume ofhematoma was15-36ml (the average volume was23.36±7.24ml. Allpatients proformed DTI scan within48hours and14days after onset, thefractional anisotropy (FA) and the diffusion tensor tractography (DTT) ofcorticospinal tract (CST) in the affected and unaffected side were obtained.The minimally invasive treatment group was divided into A sub-group (1-2grade,22patients) and B sub-group (3grade,30patients) according to the integrity of CST. The data were compared between minimally invasivetreatment group and medical treatment group, and also between Asub-group and B sub-group.Results: The initial DTI scanning showed that FA values of CST ininternal capsule and cerebral peduncle of affected side were significantlydecreased as compared with the unaffected side, there were not significantdifferences in two groups (P>0.05). The second DTI scanning displayedthat FA values of internal capsule (0.49±0.02) and cerebralpeduncle(0.47±0.03) in minimally invasive treatment group weresignificantly increased as compared with the medical treatment group(0.39±0.02;0.43±0.03)(P<0.05), respectively, and the recovery extent ofCST in minimally invasive treatment group were better than the medicaltreatment group observed by DTT, which illustrated effects of minimallyinvasive treatment were superior than medical treatment. Thepost-operative FA values of A sub-group (0.51±0.02) were higher than Bsub-group (0.48±0.02)(P<0.05)in minimally invasive treatment group,which meant better effects of operation rest with less injury of CST.Conclusion:To improve the outcome of motor function, minimallyinvasive treatment should be performed more actively of patients withsmall to medium hypertensive HICH in basal ganglia, especially CSTwhich was displaced and deformed (1-2grade) by the hematoma accordingto the DTT type. Part two: Evaluate effects of minimally invasive techniques forevacuation of small to medium hematoma in patients with hypertensiveintracerebral hemorrhage in basal ganglia: observed by diffusiontensor imagingObjective: The aim of this study was to evaluate and predict theneuromotor and functional outcome of hypertensive intracerebralhemorrhage (HICH) in basal ganglia by using diffusion tensor imaging(DTI) and diffusion tensor tractography (DTT) in the acute phase.Methods:40patients with HICH in basal ganglia were prospectivelystudied with DTI within48hours after onset,21male and19female, agefrom39to84(59.83±11.55) years, the volume of hematoma was10-29ml(the average volume was23.36±7.24ml). All patients proformed DTI scanwithin48hours after onset. A region-of-interest-based analysis wasperformed for the fractional anisotropy (FA) of the corticospinal tract (CST)in the bilateral internal capsule, the ratio of the FA (rFA) between theaffected side and the unaffected side was calculated. According to the DTTtype and the integrity of CST, all patient was divided into A sub-group (1grade), B sub-group (2grade) and C sub-group (3grade). All of the scoresfor evaluating motor function and functional outcome of the affectedextremities were measured twice: at the onset of stroke and at3monthsfollowing HICH onset, which was assessed by the modified Brunnstromclassification (MBC), functional ambulation category (FAC) and the Modified Rankin Scale (mRS).Results: The initial evaluating results did not show a significantdifferernce according to DTT type and the scores of evaluatingmeasurement were low. In the second evaluating results, scores of MBCand FAC increased than initial one, which were differed significantlyaccording to the DTT type (p <0.05), All motor scales were highest in theDTT type A group, and were lowest in the DTT type C group. Meanwhile,take rFA as the independent variable and twice evaluation index as thedependent variable, then the rFA positive correlated with the second MBCand FAC significantly and negative correlated with the mRS significantly(p <0.01).Conclusion: We conclude that DTI and DTT findings for CST canevaluate the motor deficit quantitatively and may predict the functionaloutcome in patients with an HICH in basal ganglia who were scannedwithin48hours after the HICH onset.