Based On Diffusion Tensor Imaging To Explore The Effect And Mechanism Of Hyperbaric Oxygen Therapy On Motor Dysfunction In Patients With Hypertensive Intracerebral Hemorrhage

Objective:In this study,we observed the changes of corticospinal tract(CST)in different parts of patients with hypertensive intracerebral hemorrhage(HICH)before and after hyperbaric oxygen(HBO)treatment by diffusion tensor imaging.Using Fugl-meyer Motor Function Assessment Table to explore whether the early DTI parameter rFA is used as a predictor of motor function prognosis in HICH.To analyze the efficacy and possible imaging mechanisms of HBO improves motor dysfunction after intracerebral hemorrhage.Methods:In this study,40 patients who met the requirements of the test were selected after HICH in the basal ganglia.They were randomly divided into hyperbaric oxygen and control group with 20 cases each.All patients received medication and rehabilitation.The patients in the hyperbaric oxygen group have received additional hyperbaric oxygen therapy,once a day,five times a week,ten times for a period of treatment,and two courses of treatment totally.After the completion of DTI inspection before and 4 weeks after the treatment in all patients,we measured the ipsilateral and contralateral fractional anisotropy(FA)values of corona radiata,posterior limb of internal capsule and cerebral peduncle.We calculated the rFA values(FA value of affected side/FA value of healthy side),and evaluated motor function using Fugl-Meyer motor assessment(FMA).We reconstructed the diffusion tensor tractography(DTT)image,and obtained the 3D color CST fiber bundle diagram.According to the degree of CST damage,we classified patients into grade?,?and?.Through the combination DTI parameter rFA and FMA scale,we observed three levels of the CST changes and the recovery of FMA scale in patients with different degrees of CST damaged before and after treatment,contrasted the correlation between rFA value and FMA scores.To explore the effect and the imaging mechanism of HBOT on improving the motor function of HICH patients.Results:1.Before the treatment,in general data,the FMA score,the ratio of CST injury composition,FA and rFA value between the two groups had no statistical significance(P>0.05).2.Before the treatment,the FA values of the affected side of the corona radiata,posterior limb of the internal capsule and the cerebral peduncle were lower than those of the healthy side,after the treatment,the FA value of the affected side in the three levels was higher than that before treatment,and the above differences were statistically significant(P < 0.01),while the FA value of the healthy side was not significantly different from that before treatment(P > 0.05).3.After treatment,the rFA value of corona radiata was significantly higher than that before treatment in patients with CST injury grade?,?and?(P < 0.05).The rFA value and FMA score of posterior limb of internal capsule were significantly higher than those before treatment in patients with CST injury grade ? and ?(P < 0.05).The rFA values of cerebral peduncle were significantly higher than those before treatment in patients with CST injury grade?(P < 0.05).There was no significant difference in rFA value and FMA score of posterior limb of internal capsule and cerebral peduncle compared with those before treatment after CST injury grade ?(P > 0.05).4.After the treatment,the FMA scores and rFA values of corona radiata,posterior limb of internal capsule and cerebral peduncle in patients with CST injury grade ? and ? in the hyperbaric oxygen group were significantly difference between the two groups(P < 0.05).Compared with the control group,the rFA value of the posterior limb of the internal capsule increased significantly in the patients with CST injury grade ?,but there was no significant difference in the rFA value and FMA score of the corona radiata and cerebral peduncle between the two groups(P > 0.05).5.The rFA values of the three levels before treatment were positively correlated with the FMA score after treatment.The changes of rFA in the posterior limb of internal capsule and cerebral peduncle in hyperbaric oxygen group before and after treatment were positively correlated with the changes of FMA.There was no correlation between the remaining parts.Conclusions:1.After the occurrence of HICH in basal ganglia,the CST of the affected side was damaged,and after comprehensive treatment,the CST of the affected side could be partially recovered.2.The rFA value of corona radiata,posterior limb of internal capsule and cerebral peduncle in the early stage can be used as an important index to predict the recovery of motor function in the HICH patients.3.Hyperbaric oxygen therapy combined with exercise rehabilitation training can increase FMA score and effectively improve motor function of HICH patients with CST injury grade ? and ?.The mechanism of hyperbaric oxygen improving motor function may be closely related to the remodeling of CST in the posterior limb of the internal capsule and the cerebral peduncle.