弥漫性轴索损伤磁共振频谱定量研究
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摘要
目的采用绝对定量法对早期弥漫性轴索损伤(DAI)患者进行质子磁共振频谱(1H-MRS)研究,探讨DAI脑代谢物变化与病情及预后的相关性。方法应用1.5 T磁共振机对来汕头大学第二附属医院就诊的45例DAI患者和20例健康志愿者行常规MRI平扫及双侧枕叶皮质区1H-MRS检查。45例DAI患者根据病情分为轻型组(GCS>8)和重型组(GCS≤8);根据预后情况分为良好组(GOS=5)和不良组(GOS 2～4),检测其脑组织中N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)等脑代谢物,并采用LCModel软件对代谢物的绝对浓度进行定量分析。结果对照组、轻型组以及重型组枕叶NAA、NAA/Cr、Cho/Cr比较,差异有统计学意义(F=1.02、1.21、0.12,P<0.05),NAA、NAA/Cr三组间两两比较,差异有统计学意义(P<0.05),重型组与对照组比较Cho/Cr差异有统计学意义(P<0.05);对照组、预后良好组以及预后不良组枕叶NAA、NAA/Cr、Cho/Cr比较,差异有统计学意义(F=1.12、1.25、0.08,P<0.05),Cr、Cho比较差异无统计学意义(F=3.48、0.42,P>0.05),三组间NAA、NAA/Cr两两比较,差异有统计学意义(P<0.05),预后不良组与对照组比较Cho/Cr差异有统计学意义(P<0.05),预后良好组与预后不良组比较Cho/Cr差异也有统计学意义(P<0.05);NAA浓度、NAA/Cr与昏迷时间及DRS呈负相关,与GCS、GOS呈正相关;Cho/Cr与昏迷时间、DRS呈正相关,与GCS、GOS呈负相关。结论 DAI患者脑代谢物的变化,可作为评估DAI脑组织损伤程度和预后判断的客观指标。
Objective To conduct proton magnetic resonance spectrum(1H-MRS) research with absolute quantification study of the early-stage diffuse axonal injury(DAI) patients to explore their brain metabolite changes in relevance to the degree of illness and prognosis.Methods Forty-five DAI patients visited the Second Affiliated Hospital of Shantou University and twenty healthy volunteers were studied by 1.5T magnetic resonance imaging machine,routine MRI scan and 1H-MRS examination(single voxel in the occipital gray matter).Forty-five cases of DAI were divided into mild group(GCS > 8) and severe group(GCS≤8) according to severity,divided into good outcome group(GOS = 5) and poor outcome group(GOS 2-4) according to the prognosis of the patients.The main metabolites of N-acetyl aspartic acid(NAA),choline(Cho),creatine(Cr) were quantitatively analyzed by LCModel software.Results The level of NAA and NAA/Cr,Cho/Cr were significantly different(F = 1.02,1.21,0.12,P < 0.05) among the control group,mild group,and severe group.NAA and NAA / Cr of the three groups were different with statistical significance(P < 0.05).There was statistical significance in severe group compared with the control group differences in Cho / Cr(P < 0.05).The level of NAA,NAA / Cr and Cho / Cr were different(F = 1.02,1.21,0.08,P < 0.05) among the control group,good outcome group,and poor outcome group,but there were no statistical differences betweenCr,Cho(F = 3.48,0.42,P > 0.05),NAA and NAA / Cr of the three groups had statistically significant differences(P < 0.05).There was statistical significance differences of Cho / Cr between the poor outcome group and the control group(P < 0.05),and between the good outcome group and the poor outcome group(P <0.05).The concentration of NAA,NAA/Cr were positively correlated with GCS or GOS,negatively correlated with the time of primary coma and DRS.Cho / Cr was positively correlated with the time of primary coma and DRS,and negatively correlated with GCS or GOS.Conclusion Brain metabolite changes in DAI patients can be used as objective indicators for evaluation of brain tissue injury degree and prognosis judgment.
Objective To conduct proton magnetic resonance spectrum(1H-MRS) research with absolute quantification study of the early-stage diffuse axonal injury(DAI) patients to explore their brain metabolite changes in relevance to the degree of illness and prognosis.Methods Forty-five DAI patients visited the Second Affiliated Hospital of Shantou University and twenty healthy volunteers were studied by 1.5T magnetic resonance imaging machine,routine MRI scan and 1H-MRS examination(single voxel in the occipital gray matter).Forty-five cases of DAI were divided into mild group(GCS > 8) and severe group(GCS≤8) according to severity,divided into good outcome group(GOS = 5) and poor outcome group(GOS 2-4) according to the prognosis of the patients.The main metabolites of N-acetyl aspartic acid(NAA),choline(Cho),creatine(Cr) were quantitatively analyzed by LCModel software.Results The level of NAA and NAA/Cr,Cho/Cr were significantly different(F = 1.02,1.21,0.12,P < 0.05) among the control group,mild group,and severe group.NAA and NAA / Cr of the three groups were different with statistical significance(P < 0.05).There was statistical significance in severe group compared with the control group differences in Cho / Cr(P < 0.05).The level of NAA,NAA / Cr and Cho / Cr were different(F = 1.02,1.21,0.08,P < 0.05) among the control group,good outcome group,and poor outcome group,but there were no statistical differences betweenCr,Cho(F = 3.48,0.42,P > 0.05),NAA and NAA / Cr of the three groups had statistically significant differences(P < 0.05).There was statistical significance differences of Cho / Cr between the poor outcome group and the control group(P < 0.05),and between the good outcome group and the poor outcome group(P <0.05).The concentration of NAA,NAA/Cr were positively correlated with GCS or GOS,negatively correlated with the time of primary coma and DRS.Cho / Cr was positively correlated with the time of primary coma and DRS,and negatively correlated with GCS or GOS.Conclusion Brain metabolite changes in DAI patients can be used as objective indicators for evaluation of brain tissue injury degree and prognosis judgment.
引文
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[11]Graham GD,Hwang JH,Rothman DL,et al.Spectroscopic assess-ment of alterations in macromolecule and small-molecule metabo-lites in human brain after stoke[J].Stroke,2001,32(12):2797-2802.
[2]Kreis R,Arcinue E,Ernst T,et al.Hypoxic encephalopathy afternear-drowning studied by quantitative 1H-magnetic resonancespectroscopy[J].J Clin Invest,1996,97(5):1142-1154.
[3]Auld KL,Ashwal S,Holshouser BA,et al.Proton magnetic reso-nance spectroscopy in children with acute central nervous systeminjury[J].Pediatr Neurol,1995,2(4):323-334.
[4]Holshouser BA,Tong KA,Ashwal S.Proton MR Spectroscopic ImagingDepicts Diffuse Axonal Injury in Children with Traumatic BrainInjury[J].AJNR Am J Neuroradiol,2005,26(12):1276-1285.
[5]Jansen JF,Backes WH,Nicolay K,et al.1H MR Spectroscopy ofthe Brain:Absolute Quantification of Metabolites[J].Radiology,2006,240(2):318-329.
[6]Choe BY,Suh TS,Choi KH,et al.Neuronal dysfunction in patientswith closed head injury evaluated by in vivo 1H magnetic reso-nance spectroscopy[J].Invest Radiol,1995,30(8):502-506.
[7]Shutter L,Tong KA,Lee A,et al.Prognostic Role of Proton Mag-netic Resonance Spectroscopy in Acute Traumatic Brain Injury[J].J Head Trauma Rehabil,2006,21(4):224-349.
[8]Hunter JV,Thornton RJ,Wang ZJ,et al.Late Proton MR Spectros-copy in Children after Traumatic Brain Injury:Correlation withCognitive Outcomes[J].AJNR Am J Neuroradiol,2005,26(3):482-488.
[9]Marmarou A,Foda MA,van den Brink W,et al.A new model ofdiffuse brain injury in rats.Part I:Pathophysiology and biomechanics[J].J Neurosury,2004,80(2):301-313.
[10]Henry PG,Oz G,Provencher S,et al.Toward dynamic isotopomeranalysis in the rat brain in vivo:Automatic quantitation of 13CNMR spectra usingLCModel[J].NMR Biomed,2003,16(6/7):400-412.
[11]Graham GD,Hwang JH,Rothman DL,et al.Spectroscopic assess-ment of alterations in macromolecule and small-molecule metabo-lites in human brain after stoke[J].Stroke,2001,32(12):2797-2802.