| Objective To study the diffusion anisotropic(FA) features and the impairment degree of cortical spinal tract(CST) of 20 cases with hypertensive intracerebral hemorrhage(HICH) by using diffusion tensor imaging (DTI). To investigate the mechanism of nerve ability injuring and improving from the point of view of molecular imaging,and gain theoretical data for establishment of therapeutic plan of individuality and prognosis prediction.Methods 20 patients with HICH in basal ganglion region were enrolled in this study.Admission rules:①All the patients with hemotomas of 10～30ml.②All the patients were sober and can go with examination in the head of magnetic resonance.③Hemotomas were located in monolateral basal ganglion region .④The main clinical symptoms were hemiplegia. 20 Patients were divided into 2 groups.Group 1 (drug group) consisted of 10 patients, 7 males and 3 females (age:44～82, average:61.1). Group 2 (operation group) consisted of 10 patients, 8 males and 2 females (age:51～75, average:59.6). The patients of Group 1 received routine internal medicine therapy. The patients of Group 2 underwent stereotactic hematoma aspiration. All the patients underwent conventional MRI and DTI examination after admitted (TE/TR: 112minimum/10000ms, matrix:128×128 , FOV: 240mm,thickness:4.0mm, spaceing:0.5mm,b value:1000s/mm2,) using GE sina exite imaging system. The data were postprocessed to generated fractional anisotropy maps by the software of Dtv.Ⅱ.R2. The FA value were measured in the region of compressed CST and corresponding contralateral normal regions ,and directionally encoded color maps and 3D tractography of bilateral CST of all patients were created. NIHSS scores were calculated for assessment of nerve ability injuring and the Brunnstrom scale were employed for assessment of the functional status before treatment, and the third month,sixth month after the onset of the illness. The relationship between the impairment degree of CST and the level of nerve ability injuring and improving was analyzed. One patient was re-examined by a DTI protocol 13 days after operation. The neurological recover was observed dynamically by follow-up.And one patient who have been with HICH for 7.5 years and underwent stereotactic hematoma aspiration 17 days after the onset of the illness was enrolled in this study, he also underwent conventional MRI and DTI examination.Results The FA value in the region of compressed CST was significant lower than that in normal hemisphere(paired test, t=9.1112,p<0.05). FA images and DEC maps can display corticospinal tract clearly. DTI shows that the CST were compression, displacement, translocation, and break. The decreasing percentage of FA value in the region of compressed CST has significant positive correlation with NIHSS scores 1 (r=0.7226,p<0.05);The impairment degree of CST is related with muscular strength of contralateral limb(spearmen correlation, rs'=-0.9083,p<0.05). By following survey, we find that:①all the patients with compressed CST were restored visibly,the rest patients were restored limitedly,it shows that patients with compressed CST should received routine internal medicine therapy;②16 Patients had severely broke CST,8 patients received operation, the others received conservative treatment, operation group's NIHSS scores recovered obviouslier than the conservative treatment group's, it shows that patients with severely broke CST should received operation therapy;③the nerve ability of patients with HICH improving visibly in 3 months after the onset of illness.Conclusion For patients with HICH in basal ganglion region, We can evaluate their impairment degree of CST by using diffusion tensor imaging; There are conclusive correlativity between the impairment degree of CST and the level of nerve ability injuring and improving, we can establish therapeutic plan of individuality and predict prognosis. |
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