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目的:探讨术前弥散张量成像（DTI）对中等量高血压性基底节区脑出血患者微创血肿穿刺术后运动功能预后的评估作用。方法:回顾性选择郴州市第一人民manbet官网登录 神经外科自2018年3月至2019年12月收治的54例中等量（30~50 mL）高血压性基底节区脑出血患者。所有患者均于发病24 h内行DTI，测量大脑脚患侧、健侧各向异性分数（FA）和平均弥散率（MD），并转换为相对各向异性分数（rFA）和相对平均弥散率（rMD）。DTI后24 h内接受微创血肿穿刺术治疗，术后90 d采用运动功能评分（MFS）评估患者肢体运动功能的预后，并依据MFS评分将患者分为运动功能预后良好组（MFS评分0~3分）、运动功能预后不良组（MFS评分4~8分）。比较2组患者临床资料和DTI指标的差异，采用受试者工作特征（ROC）曲线分析术前DTI的rFA值对患者术后90 d肢体运动功能预后的预测效能。结果:54例患者均顺利完成微创血肿穿刺术，无颅内感染和明显再出血发生。术后90 d运动功能预后良好22例（40.7%），运动功能预后不良32例（59.3%）。运动功能预后良好组与运动功能预后不良组患者的年龄、性别分布、入院时格拉斯哥昏迷量表评分、术前血肿量、术后残余血肿量的差异均无统计学意义（ P>0.05）。与运动功能预后良好组比较，运动功能预后不良组患者大脑脚患侧FA值、rFA值均较低，差异均有统计学意义（ P<0.05）。ROC曲线分析显示术前rFA值预测患者术后90 d肢体运动功能的曲线下面积为0.984，截断值为0.78，灵敏度为100%，特异度为96.9%。 结论:术前DTI的rFA值可有效预测中等量高血压性基底节区脑出血患者微创血肿穿刺术后90 d的肢体运动功能。

Objective:To explore the value of preoperative diffusion tensor imaging (DTI) in predicting motor function outcomes in patients with moderate-volume basal ganglia cerebral hemorrhage after minimally invasive puncture and drainage.Methods:A retrospective study was performed; 54 patients with moderate-volume hypertensive basal ganglia hemorrhage (30-50 mL) admitted to Department of Neurosurgery, First People's Hospital of Chenzhou from March 2018 to December 2019 were enrolled. All patients accepted DTI within 24 h of onset; fractional anisotropy (FA) and mean diffusivity (MD) of the bilateral cerebral peduncles were measured and converted to relative FA (rFA) and relative MD (rMD). Patients accepted minimally invasive puncture and drainage within 24 h of DTI. Motor function score (MFS) was used to evaluate the prognoses of limb motor function 90 d after puncture and drainage; and these patients were divided into good motor function outcome group (MFS scores of 0-3) and poor motor function outcome group (MFS scores of 4-8). The clinical data and DTI indexes were compared between the 2 groups; receiver operating characteristic (ROC) curve was used to analyze the efficacy of rFA in preoperative DTI in predicting limb motor function 90 d after puncture and drainage.Results:Fifty-four patients successfully completed minimally invasive puncture and drainage, without intracranial infection or obvious rebleeding. Twenty-two patients (40.7%) had good motor function outcome and 32 (59.3%) had poor one 90 d after puncture and drainage. No significant difference in age, gender, Glasgow coma scale score at admission, preoperative hematoma volume or postoperative residual hematoma volume was noted between the good function outcome group and poor function outcome group ( P>0.05). Compared with the good function outcome group, the poor function outcome group had statistically lower FA and rFA in the affected side of cerebral peduncles ( P<0.05). ROC curve showed that the area under the curve of preoperative rFA in predicting motor function 90 d after puncture and drainage was 0.984, with cutoff value of 0.78, sensitivity of 100%, and specificity of 96.9%. Conclusion:Preoperative DTI can effectively predict limb motor function 90 d after minimally invasive puncture and drainage in patients with moderate-volume hypertensive basal ganglia hemorrhage.