McCourt Rebecca, Misaghi Ehsan, Tu Wei, Kate Mahesh, Gioia Laura, Treit Sarah, Beaulieu Christian, Butcher Ken S
Neuroscience and Mental Health Institute, University of Alberta, Canada; Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Canada.
Neuroscience and Mental Health Institute, University of Alberta, Canada; Department of Rehabilitation Medicine, Institute of Stuttering Treatment and Research, University of Alberta, Canada.
J Neurol Sci. 2021 Feb 15;421:117317. doi: 10.1016/j.jns.2021.117317. Epub 2021 Jan 12.
The impact of perihematoma edema in Intracerebral Hemorrhage (ICH) on white matter integrity is uncertain. Fractional Anisotropy (FA), as measured with Diffusion Tensor Imaging (DTI), can be used to assess white matter microstructure. We tested the hypotheses that sections of the Corticospinal Tract (CST) passing through perihematoma edema would 1) have low FA relative to the contralateral CST and 2) would predict NIHSS motor score in ICH patients.
Patients were prospectively imaged with DTI at 48 h and 7 days after onset. Edema volume/extent was measured on CT at baseline and 24 h. FA, mean, axial and radial diffusivity were measured in the perihematoma edema, contralateral CST and sections of CST passing through the edema ('edematous CST').
Patients (n = 27, mean age 67 ± 13) were scanned with DTI at a median (IQR) of 42.3 (24.5) hours and 7.7 (1.8) days from onset. Median acute ICH volume was 8.8 (22) ml. FA in edematous CST at 72 h was decreased (0.37 ± 0.03) relative to contralateral CST (0.52 ± 0.06; p < 0.0001). Day 7 FA in edematous CST (0.35 ± 0.08) was also decreased compared to contralateral CST (0.54 ± 0.06; p < 0.0001). FA remained stable between 72 h (0.37 ± 0.03) and day 7 (0.35 ± 0.07; p = 0.350). FA at 72 h (ρ = -0.22, p = 0.420) and day 7 (ρ = -0.14, p = 0.624) was unrelated to 90-day motor score.
FA is decreased in the CST where it passes through the edema. Decreased FA in the edematous CST remained stable over time, was unrelated to motor score, and may represent water infiltration into the tracts rather than axonal injury.
脑出血（ICH）周围血肿水肿对白质完整性的影响尚不确定。弥散张量成像（DTI）测量的分数各向异性（FA）可用于评估白质微观结构。我们检验了以下假设：穿过血肿周围水肿的皮质脊髓束（CST）节段1）相对于对侧CST具有较低的FA，以及2）可预测ICH患者的美国国立卫生研究院卒中量表（NIHSS）运动评分。
患者在发病后48小时和7天接受DTI前瞻性成像。在基线和24小时时通过CT测量水肿体积/范围。在血肿周围水肿、对侧CST以及穿过水肿的CST节段（“水肿性CST”）中测量FA、平均扩散率、轴向扩散率和径向扩散率。
患者（n = 27，平均年龄67±13岁）在发病后的中位（四分位间距）42.3（24.5）小时和7.7（1.8）天接受DTI扫描。急性ICH的中位体积为8.8（22）ml。与对侧CST（0.52±0.06；p < 0.0001）相比，72小时时水肿性CST中的FA降低（0.37±0.03）。与对侧CST（0.54±0.06；p < 0.0001）相比，第7天水肿性CST中的FA（0.35±0.08）也降低。FA在72小时（0.37±0.03）和第7天（0.35±0.07；p = 0.350）之间保持稳定。72小时（ρ = -0.22，p = 0.420）和第7天（ρ = -0.14，p = 0.624）时的FA与90天运动评分无关。
CST穿过水肿部位时FA降低。水肿性CST中降低的FA随时间保持稳定，与运动评分无关，可能代表水浸润到神经束中而非轴突损伤。
