ASSESSMENT OF THE PYRAMIDAL TRACT BY DIFFUSION TENSOR ANALYSIS IN BRAIN HEMORRHAGE PATIENTS FOR MOTOR FUNCTION PROGNOSIS

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  • 脳出血患者の拡散テンソル解析による錐体路の評価と運動機能予後
  • ノウ シュッケツ カンジャ ノ カクサン テンソル カイセキ ニ ヨル スイタイロ ノ ヒョウカ ト ウンドウ キノウ ヨゴ

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In patients with brain hemorrhage, the entire visualized pyramidal tract was established as an area of interest (ROT) . Its Fractional Anisotoropy (FA) value was determined by diffusion tensor analysis (DTA), and its relationship to motor function at the onset and three months later was investigated. In 30 patients with brain hemorrhage accompanying paralysis, MRI was performed during the subacute phase (6-14 days after onset) . In addition, using a workstation, DTA was performed in order to visualize the pyramidal tract. The FA of the ROT was measured on the affected and unaffected sides, and as previously reported, the ratio of FA in the affected and unaffected sides was calculated. Subsequently, we examined the relationship between the FA ratio and motor function prognosis. Motor function prognosis was assessed based on the sum of the Brunnstrom stage at the onset and three months later. A strong correlation coefficient existed between the FA ratio of the entire pyramidal tract and the sum of the Brunnstrom stage three months after onset (0.74, p<0.001), and prognosis of motor function tended to improve in patients with FA ratios of 0.95 or higher. Patients with mild paralysis were identified in order to ascertain the degree of improvement in paralysis, and a significant correlation between the FA ratio of the entire pyramidal tract and the degree of improvement in the Brunnstrom stage was observed (correlation coefficient 0.77, p<0.001) . When compared to putamen hemorrhage, the FA ratio affected the prognosis of paralysis more in thalamic hemorrhage. The results suggest that in patients with an FA ratio of 1.0, the recovery rate of paralysis three months after onset is markedly high. In brain hemorrhage patients, a reduction in the FA ratio of the entire pyramidal tract was correlated with the functional prognosis of motor paralysis, and in thalamic hemorrhage, it may be possible to predict motor function based on FA ratios. Hence, the DTA of the pyramidal tract in brain hemorrhage patients appears to be useful for predicting function.

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