The Application Of Magnetic Resonance Diffusion Tensor Imaging In The Basal Ganglia Of Hypertensive Intracerebral Hemorrhage

Objective:This study attempts to use magnetic resonance diffusion tensor imaging (DTI)to observe the injury of CST and OR on basal ganglia of hypertensive intracerebral hemorrhage (HICH) and estimate the outcome of functional.Methods:23cases of basal ganglia HICH by CT diagnosed,14males and9females, aged45-75years old, mean62years old, mainly as the putamen, thalamus hemorrhage, caudate nucleus is only one case,On admission, hematoma volume is calculated by coniglobus formula on CT(5-30ml),judging ipsilateral limb muscle strength;4cases of post-surgical patients (3patients with transcortical-transtemporal approach, one case of transsylvian-transinsular approach),From the onset to the DTI scan is14-20days;Take20normal Volunteers as the normal group,10males and10females, aged35-70years old, mean50years old. After DTI scan, the datas were processed by the FiberTrak tool of PHILIPS EMW2.6.3.4(Extended MR Workspace2.6.3.4) software.Measure the CST FA values of internal capsule and cerebral peduncle area respectively, calculate the relative FA values (rFA) and decrease FA values (dFA); The FA and apparent diffusion coefficient(ADC) values of OR in the lateral triangle plane were measured in both hemispheres, The CST and OR type of injury were divided into four groups.Manually drawn ROIs to rebuild the bilateral CST and OR, superimposed to the DWI image, observe the extent damage of them and the relationship between the hematoma. Ipsilateral upper and lower extremity muscle strength were graded separately one month later, using the Modified Rankin Scale (mRS) to score their motor function after six months. SPSS11.5software for datas analysising, Paired t test for CST-FA values and OR-FA, ADC values of bilatera in normal and patient group respectively,p<0.05is statistically significant; Using Pearson correlation coefficient analysis for hematoma volume with ipsilateral CST-FA and rFA values of internal capsule and cerebral peduncle region and OR-FA,ADC values in all patients, P<0.05is statistically significant;Pearson correlation coefficient analysis for internal capsule and cerebral peduncle region CST-rFA,dFA values with mRS scores in all patients, p<0.05is statistically significant; Paired t test for bilateral CST-FA values, p<0.05is statistically significant; Paired t test for ipsilateral upper limb and lower limb muscle strength on admission and one month later of each CST level,p<0.05is statistically significant; Analysising the DTI-CST and OR diagram of postoperative patients combined with surgery,to explore the surgical approach is good or bad(Less samples, can’t do statistical analysis).Results:Normal group CST-FA,OR-FA, ADC values were not significantly different after test (P>0.05);Pearson correlation analysis for Hematoma volume and CST-FA, rFA values,OR-FA,ADC values,respectively,the result of p are all over than0.05; CST-FA values of contralateral side were higher than the ipsilateral (p<0.05); CST-rFA value and mRS score was negatively correlated (p<0.05); When the rFA value increase,mRS scores will decrease,better of prognosis;Internal capsule, cerebral peduncle region CST-dFA value not associated with mRS score (p>0.05); Muscle strength on admission and one month later of each CST level group,the result of p are all less than0.05, with higher CST injury level, the lower muscle strength. The muscle strength will recover along with the time.There is a total of7cases (30%) in patients complete no damage to OR, no obvious abnormalities;16cases (approximately70%) OR injury, appears OR-FA values, ADC abnormalities. Each grade OR, the bilbilateral OR-FA and ADC value through paired t test (P<0.05), significant differences; OR-IV type can not be rebuilt ipsilateral OR, significantly worse than the contralateral side; Higher grade of OR, the more severe injury.Conclusion:The three-dimensional relationship between hematoma and CST,OR observed by DTI can determine the extent injury of them,it is impotent for evaluating the motor dysfunction and visual defects; CST-rFA value can reflect the degree of damage to CST, and is associated with the mRS score; The result suggests that patients with HICH of basal ganglion are at high risk of OR injury,OR-FA, ADC values can reflect the degree of injury; Hematoma volume has nothing to do with CST and OR damage;At the same time, in protecting the OR and CST, transcortical-transtemporal(TS-TI) approach may be superior to the transcortical-tran stemporal (TC-TT) approach.