Study Of Remote Lesion From Intracerebral Hemorrhage And Cerebral Infarction Using Diffusion Tensor Imaging (DTI) And Voxel-based Morphometry(VBM)

Purpose: Neuroanatomical,neuroimaging and cytological studies demonstrated that there were remote lesions secondary to cerebral infarction or cerebral hemorrhage.The differences of remote lesions between cerebral infarction and cerebral hemorrhage are uncertain,and the same as different size of focal injuries.The present study was to investigate the differences of remote lesions between the cerebral infarction and cerebral hemorrhage,and the differences between different size of focal injuries,using magnetic resonance imaging(MRI),voxel-based morphometry(V-BM)and diffusion tensor imaging(DTI).Method: Consecutive patients admitted with stroke to the department of neurology,the Second Clinical Medical College of Jinan University(Shenzhen People’s Hospital)from December 2016 to November 2017 were included.The inclusion criteria were as follows: 1)onset within the first week after stroke;2)unilateral cerebral infarction or cerebral hemorrhage in basal ganglia or centrum ovale without any other lesions on MRI;3)volume of cerebral infarction or cerebral hemorrhage were 5-8m L or 15-20 m L.Each patient completed MRI T1/T2/FLAIR/DWI/DTI sequence testing and assessment of NIHSS(national institute health stroke scale)and BI(Barthel Index)within 7 days of onset.Voxel-based morphometry(VBM)was uniformly applied to all subjects to evaluate the volume of different brain regions,and diffusion tensor imaging(DTI)technique was applied to measure mean diffusivity(MD)and fractional anisotropy(FA)in the region of interest(ROI).Result: 1.33 cases of cerebral infarct patients with 5-8m L of volume(small infarct group)and 23 cases with15-20 m L of volume(large infact group),25 cases of cerebral hemorrage patients with 5-8m L of hematoma (small hematoma group)and 18 cases with15-20 m L of hematoma(large hematoma group),were included in the present study.2.The voxel value in the focal superior frontal gyrus,focal anterior cingutate,focal midbrain in small infarct group was significantly larger than that in the large infarct group(P<0.05);the voxel value in the focal superior frontal gyrus,focal superior parietal lobule,bilateral anterior cingulate gyrus,bilateral posterior cingulate gyrus,focal medulla in small hematoma group was significantly larger than that in large hematoma group(P<0.05);compared with small infarct group,the voxel value in the contralateral midbrain,bilateral pons,and bilateral medulla in small hematoma group was significantly smaller(P<0.05).compared with large infarct group,the voxel value in the focal superior frontal gyrus,bilateral superior parietal lobule,bilateral anterior cingulate gyrus,bilateral posterior cingulate gyrus in large hematoma group was significantly smaller(P<0.05).3.Compared with small infarct group,MD value in the mirror site was significantly larger and FA value in the mirror site was significantly smallerin large infarct group(P<0.05);compared with small hematoma group,FA value in the bulbar medulla oblongata,contralateral medulla oblongata,focal contralateral pons,lesions contralateral midbrain and mirror site was significant larger in small infarct group(P<0.05).There was no significant difference in FA value and MD value in each ROI either between small hematoma group and larger hematoma group,or between large hematoma group and large infarct group(P>0.05).Conclusion: 1.Remote lesion from large cerebral infarct is more severe than that from small cerebral infarct.2.Remote lesion from large cerebral hematoma is more severe than that from small cerebral hematoma.3.Compared with cerebral infarction,remote lesion from cerebral hemorrhage with similar volume is more severe.