From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain.
AJNR Am J Neuroradiol. 2019 May;40(5):769-775. doi: 10.3174/ajnr.A6038. Epub 2019 Apr 18.
BACKGROUND AND PURPOSE: Predicting motor outcome following intracerebral hemorrhage is challenging. We tested whether the combination of clinical scores and DTI-based assessment of corticospinal tract damage within the first 12 hours of symptom onset after intracerebral hemorrhage predicts motor outcome at 3 months. MATERIALS AND METHODS: We prospectively studied patients with motor deficits secondary to primary intracerebral hemorrhage within the first 12 hours of symptom onset. Patients underwent multimodal MR imaging including DTI. We assessed intracerebral hemorrhage and perihematomal edema location and volume, and corticospinal tract involvement. The corticospinal tract was considered affected when the tractogram passed through the intracerebral hemorrhage or/and the perihematomal edema. We also calculated affected corticospinal tract-to-unaffected corticospinal tract ratios for fractional anisotropy, mean diffusivity, and axial and radial diffusivities. Motor impairment was graded by the motor subindex scores of the modified NIHSS. Motor outcome at 3 months was classified as good (modified NIHSS 0-3) or poor (modified NIHSS 4-8). RESULTS: Of 62 patients, 43 were included. At admission, the median NIHSS score was 13 (interquartile range = 8-17), and the median modified NIHSS score was 5 (interquartile range = 2-8). At 3 months, 13 (30.23%) had poor motor outcome. Significant independent predictors of motor outcome were NIHSS and modified NIHSS at admission, posterior limb of the internal capsule involvement by intracerebral hemorrhage at admission, intracerebral hemorrhage volume at admission, 72-hour NIHSS, and 72-hour modified NIHSS. The sensitivity, specificity, and positive and negative predictive values for poor motor outcome at 3 months by a combined modified NIHSS of >6 and posterior limb of the internal capsule involvement in the first 12 hours from symptom onset were 84%, 79%, 65%, and 92%, respectively (area under the curve = 0.89; 95% CI, 0.78-1). CONCLUSIONS: Combined assessment of motor function and posterior limb of the internal capsule damage during acute intracerebral hemorrhage accurately predicts motor outcome.
背景与目的：预测脑出血后的运动预后具有挑战性。我们测试了在脑出血症状发作后 12 小时内，将临床评分与基于弥散张量成像（DTI）的皮质脊髓束损伤评估相结合，是否可以预测 3 个月时的运动预后。
材料与方法：我们前瞻性地研究了在脑出血症状发作后 12 小时内出现运动障碍的原发性脑出血患者。患者接受了多模态磁共振成像，包括 DTI。我们评估了脑出血和血肿周围水肿的位置和体积，以及皮质脊髓束的受累情况。当轨迹穿过脑出血或/和血肿周围水肿时，我们认为皮质脊髓束受到影响。我们还计算了各向异性分数、平均弥散系数、轴向和径向弥散系数的受影响皮质脊髓束与未受影响皮质脊髓束的比值。运动损伤通过改良 NIHSS 的运动亚指数评分进行分级。3 个月时的运动预后分为良好（改良 NIHSS 0-3）或不良（改良 NIHSS 4-8）。
结果：在 62 例患者中，43 例被纳入研究。入院时，NIHSS 中位数为 13（四分位距=8-17），改良 NIHSS 中位数为 5（四分位距=2-8）。3 个月时，13 例（30.23%）预后不良。运动预后的显著独立预测因素包括入院时的 NIHSS 和改良 NIHSS、入院时脑出血对内囊后肢的累及、入院时的脑出血体积、72 小时 NIHSS 和 72 小时改良 NIHSS。入院时改良 NIHSS>6 联合内囊后肢受累的联合预测在发病后 12 小时内对 3 个月时运动预后不良的敏感性、特异性、阳性和阴性预测值分别为 84%、79%、65%和 92%（曲线下面积=0.89；95%置信区间，0.78-1）。
结论：在急性脑出血期间对运动功能和内囊后肢损伤进行联合评估可以准确预测运动预后。
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