Value of DTI in choice of treatment methods and prognosis evaluation of patients with moderate hypertensive basal ganglia hemorrhage

TIAN Hai-gang; WANG Ben-han; XIAO Guo-hui; LIU Wei; CAO Fu-qiang; FU Yu; LI Jing-lun

doi:10.13798/j.issn.1009-153X.2023.12.003

Abstract：Objective To investigate the value of magnetic resonance diffusion tensor imaging(DTI)in the treatment choice and prognosis assessment of patients with moderate(hemotoma volume,30～40 ml)hypertensive basal ganglia hemorrhage(HICH).Methods The clinical data of 63 patients with moderate HICH treated from January 2019 to December 2022 were retrospectively analyzed.Anisotropy score(FA)and corticospinal tract(CST)injury were measured by DTI images within 48 h and 2 weeks after the onset.Limb motor function was evaluated with the National Institutes of Health stroke scale(NIHSS)score and paralysis grading(PG)was calculated.Results Of these 63 patients,25 patients were treated conservatively(conservative group)and 38 were treated with surgery(operation group);13 patients suffered from CST injury Grade 1,21 from grade 2 and 29 from grade 3.Of the patients with CST injury grades 1～2,14 patients were treated conservatively and 20 were treated with surgery.Of the patients with CST injury grade 3,11 cases were treated conservatively and 18 patients were treated surgery.Within 48 h of onset,there was no significant difference in FA values between the two groups(P＞0.05).Two weeks after the onset,the FA values of the internal capsular area on both the normal and hemorrhagic sides were significantly improved in both groups(P＜0.05),and the FA values in the operation group were significantly better than those of the conservative group(P＜0.05).There was a significant negative correlation between the FA value at 48 h and the PG value at 2 weeks(conservative group:r=-0.769,P＜0.05;Operation group:r=-0.769,P＜0.05).In patients with CST injury grades 1～2,PG was significantly decreased after 2 weeks of onset in both conservative and operation groups(P＜0.05).In patients with CST injury grade 3,PG was significantly decreased only in the operation group(P＜0.05).Conclusions DTI can accurately evaluate the degree of CST damage in patients with moderate HICH.For patients with severe CST injury,conservative treatment often has poor prognoses,and early surgical removal of hematoma is helpful to the recovery of CST and improve the patients'prognoses.