利用弥散张量成像评价中小量基底节区高血压脑-第三军医大学学报.DOC

利用弥散张量成像评估中小量基底节区高血压脑出血微创手术的治疗效果 蒋永祥, 马 颖，程 远，陈维福 (400010重庆，重庆医科大学附属第二医院神经外科) [摘要] 目的 利用弥散张量成像(diffusion tensor imaging, DTI)评估中小量基底节区高血压脑出血的微创治疗效果。 方法 以101例中小量(10~40ml)基底节区高血压脑出血患者为对象，根据治疗方式不同分为微创手术组(52例)和内科治疗组(49例)，血肿体积为15~36 (23.36±7.24) ml。所有患者在发病后48 h内和发病后14 d进行DTI扫描，得到双侧皮质脊髓束(corticospinal tract, CST)的各向异性分数(fractional anisotropy, FA)及弥散张量纤维束成像(diffusion tensor tractography， DTT)图像，并根据CST完整性将微创手术组分为A(1~2级，22例)、B(3级，30例)两个亚组，比较微创手术组和内科治疗组之间及A、B亚组之间在以上指标的差异。 结果 发病后首次DTI扫描显示微创手术组、内科治疗组受累侧的内囊区和大脑脚FA值均降低，两组间无明显差异(P＞0.05)，第2次DTI扫描提示，微创手术组的FA值(内囊区0.49±0.02、大脑脚0.47±0.03)较内科治疗组(内囊区0.39±0.02、大脑脚0.43±0.03)明显升高(P＜0.05)，且从DTT图像上可见微创手术组的CST恢复程度明显好于内科治疗组，提示对于这类患者微创手术治疗效果优于内科治疗。微创手术组的A亚组术后FA值(0.51±0.02)高于B亚组(0.48±0.02) (P＜0.05)，提示CST损伤越小，手术效果越好。结论 微创治疗可以提高中小量基底节区高血压脑出血患者预后，尤其是DTT显示CST以推移、变形为主者(1~2级)应更为积极采取微创治疗。 [关键词] 高血压脑出血；基底节区；微创治疗技术；弥散张量成像；各向异性 Therapeutic efficiency of minimally invasive techniques for evacuating small to medium hematoma in hypertensive intracerebral hemorrhage in basal ganglia: evaluation by diffusion tensor imaging Jiang Yongxiang, Ma Ying, Cheng Yuan, Chen Weifu (Department of Neurosurgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, [Abstract] Objective To evaluate the effect of minimally invasive evacuation on small to medium hypertensive intracerebral hemorrhage (ICH) in basal ganglia by diffusion tensor imaging (DTI). Methods A total of 101 patients with small to medium hypertensive ICH in the basal ganglia who were hospitalized in our department during June 2010 to October 2011 were enrolled, and prospectively divided into 2 matched groups, a minimally invasive treatment group (n=52) and a non-surgical group (n=49). Their volume of hematoma was 15 to 36 ml, with an average volume of 23.36±7.242 ml. All patients received DTI scanning within 48 h after intracerebral hemorrhage and in 14 d after onset. Fractional anisotropy (FA) and diffusion tensor tractography (DTT) of corticospinal tract (CST) in the affected