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Objective We attempted to investigate optic radiation (OR) injury and visual field mean defect (MD) in patients with hypertensive putaminal hemorrhage by using diffusion tensor imaging (DTI). Methods Thirty-three first onset of patients with hypertensive putaminal hemorrhage and 30 normal healthy control subjects were recruited. DTI data were acquired between 3 and 5 days as well as 3 months after onset. DTI-Studio software was used to reconstruct the OR and examine the degree of OR injury (typeⅠ, Ⅱ, and type Ⅲ). Fractional anisotropies (FA) and apparent diffusion coefficient (ADC)values of the ORs were measured. Statistical analysis was performed to calculate hematoma volume, MD,OR-FA and ADC values by using SPSS 17.0 software. Results FA and ADC values of ORs were not significantly different between the two hemispheres in normal control groups (student t-test, P>0.05). Compared with MD values in control group, the visual field was significantly impaired in patients group (P<0.01). FA and ADC values of ORs were significantly different between two hemispheres in patient group (student t-test, P<0.01). There was no correlation of hematoma volume with OR-FA nor with ADC values nor with MD values (P>0.05). The MD values were correlated with OR-FA and ADC values after onset(P<0.05). MD, FA and ADC values of ORs in the affected hemisphere of the patient group were significantly different for the three OR types between 3 and 5 days as well as 3 months after onset (P<0.01). Conclusion DTI can examine the three-dimensional relationship between hematoma and OR, reflect the changes of OR morphology and predict the degree of visual-field defects.
RESUMO
Objectives To conduct grading comparison for the damage degree of pyramidal tracts after procedure in patients with unilateral hypertensive putamen hemorrhage via transsylvian-transinsular (TS-TI) approach and transcortical transtemporal (TC-TF) approach using magnetic resonance diffusion tensor imaging (DTI) and to evaluate the postoperative recovery of the patients according to the quality criteria of the activities of daily living (ADL),and to identify the advantages and disadvantages of both surgical approaches.Methods Sixty-three consecutive patients with first onset of unilateral hypertensive basal ganglia putamen hemorrhage admitted to Department of Neumlsurgery in Affiliated Hospital of Southwest Medical University of Traditional Chinese Medicine were enrolled prospectively.The volume of hematoma at admission was 26-45 ml.They were randomly divided into group A and group B by random number table.The patients in group A (n =31) were treated via the TS-TI approach,and those of group B (n =32) were treated via the TC-TT approach.The operator was the same surgeon.The patients of rebleeding were excluded (4 in group A,7 in group B),and 52 patients were actually included,including 27 in group A and 25 in group B.The DTI examinations were perforrned 5 to 8 d after procedure.The image data were processed by PHILIPS Extended MR Workspace 2.6.3.4 (EMW 2.6.3.4) software.The bilateral pyramidal tracts were reconstructed,the damage degree of pyramidal tract and its relationship with hematoma and surgical approach were observe respectively.The ADL quality criteria were used to evaluate the recovery at 3 months after procedure.The SPSS 17.0 software was used to conduct rank sum test for the pyramidal tract injury grade after procedure in both groups.The number of rebleeding in the operation areas and the ADL quality criteria evaluation were tested by Chi-squared test.Results There was no significant difference in the postoperative rebleeding rate between group A (12.9％,4/31) and group B (21.9％,7/32) (x2 =0.367,P =0.545).The postoperative pyramidal tract damage degree of group A was better than that of group B.There was significant difference (U =180.00,P =0.004).The comparison of ADL quality evaluation in both groups after procedure showed that the good prognosis rate (81.5％,22/27) of group A after procedure was better than that of group B (56.0％,14/25).There was significant difference (x2 =3.957,P =0.047).Conclusions The three-dimensional relationship between the hematoma lesions and the pyramidal tracts was observed by DTI,the damage degree of the pyramidal tracts were identified.The TS-TI approach was superior to the TC-TF approach in the postoperative damage degree of pyramidal tract and the quality of ADL for the treatment of hypertensive putamen hemorrhage.