| Objectives This study was performed to observe the injury of the corticospinal tract at different times in patients with acute hypertension intracerebral haemorrhage by Diffusion Tensor Imaging,to analyze the connection between related parameters of DTI and the recovery of the patient's nerve function.Methods 30 patients disgnosed intracerebral hemorrhage in basal ganglia through CT by emergency department of Neurology of Tangshan workers hospital from December 2016 to November 2017 were enrolled in this study.There are 21 males and 9 females,aged 39-80 years old,mean(60±10)years old,hematoma volume is calculated by Tada formula on CT(5-30ml),the average was 14.3ml.After the patients were admitted to hospital they would take a brain DTI scan(T1,average time after the onset of 6.5±1.2 hours)by the 1.5T magnetic resonance(US GE)and 8-channel standard cranial surface coil,if the conditions were allowed.On the following day(T2,average time 30±1.5 hours after onset)review the DTI,apply the white fiber tracing technique and software to postprocess the original image and reconstruct the bilateral fiber bundle images.The posterior limb of the internal capsule was selected as the region of interest(ROI)to measure the FA value(Fractional Anisotropy,FA)during the two examinations of the same patient.According to the obtained fiber bundle images,the influence of ipsilateral hematoma on the corticospinal tract was observed,such as extrusion,pass,and destruction.The National Institutes of Health Stroke Scale(NIHSS)was scored on admission and after 3 months of onset,and the patient's affected limb muscle strength was recorded.All patients were given comprehensive treatment such as maintaining stable vital sign,moderately reducing cerebral edema,reducing intracranial pressure,maintaining water and electrolyte balance,protecting brain nerves,and strengthening nutrition.SPSS 19.0 software was used to compare the difference in FA values between affected and healthy side of the same patient at different times.The correlation between CST-r FA and NIHSS scores at different times was analyzed.The relationship between the degree of damage of CST and neurological deficits was observed.Results 1 The FA value from the DTI scan of patients with acute hypertensive intracerebral hemorrhage of the affected region of interest in the cortical spinal tract was significantly lower than that of the contralateral side(P<0.05).2 There was no correlation between CST-r FA value and NIHSS score at admission,and negative correlation with NIHSS score after 3 months of onset(P<0.05).The correlation between r FA and NIHSS score was greater at T2.The T2-r FA value was lower than that of T1-r FA,and the difference was statistically significant(P<0.05).3 There was no correlation between hematoma volume and CST-r FA.4 In patients with different CST grades,the muscle strength after 3 months of the affected limb was significantly different from that at the time of admission(P<0.05),indicating that the patient's dyskinesia gradually recovered with the prolongation of the disease course;the more severe the degree of CST damage,the worse the patient's limb muscle strength.Conclusions 1 In patients with acute hypertensive intracerebral hemorrhage,the CST-r FA value obtained by DTI technique can be used to quantify the damage level of pyramidal tract and predict the severity of neurological dysfunction in patients.2 The DTT technique can observe the morphological structure of the pyramidal tract of patients with cerebral hemorrhage and its relationship with hematoma,and predict the muscle strength of the affected limb by observing the degree of injury of CST.3 There were different changes in DTI examinations at different times.Compared with admission(6.5±1.2 hours after onset),r FA values obtained was more closely related to the short-term prognosis on the day after admission(30±1.5 hours after onset). |
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