磁共振弥散成像和体感诱发电位对重型颅脑损伤的评价
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摘要
目的
探讨磁共振弥散成像和体感诱发电位对重型颅脑损伤病情及预后评估意义
方法
分析济南军区总医院神经外科和山东省立医院影像研究所2004年1月-2008年5月间收治的重型颅脑损伤患者(GCS<8分)的临床资料,其中42例为外伤或外伤术后合并梗塞患者;无梗塞合并症者62例,另20名行磁共振检查正常、与62病例组年龄、性别相匹配的健康人作对照组。所有患者均行头颅CT、常规MRI序列、DWI、DTI、检查。外伤或外伤术后梗塞组:在梗塞发生后不同时间超早期(< 6小时)、急性期(6-24小时)、亚急性期组(>1-7天)检出异常信号为阳性病例数,测梗塞侧和对侧ADC值、FA值;正常健康人20名,分别测感兴趣区:桥脑后部、丘脑、半卵园中心区、内囊后肢、胼胝体压部、额ADC值、FA值;另一组62例患者,分预后良好、预后不良两组,同样测量以上感兴趣区ADC值、FA值,并行GCS评分、纤维束DTI三维成像、体感诱发电位检查。
结果
1、外伤或外伤术后(合并)梗塞组:DWI对超急性期和急性期脑梗塞的检出率均高于CT、常规MRI (p<0.05);常规MRI包括FLAIR很难显示伤后6小时内超急性期梗塞灶;超急性期和急性期梗塞区ADC值均明显低于对侧(p<0.01),在梗塞区ADC值随病程逐渐升高,急性期和超早期ADC值无显著差异(p>O.05),亚急性期ADC值高于超早期、急性期(p <0.01);在急性期和亚急性期的梗塞区FA值均随着病程进展逐渐降低,急性期和亚急性期FA值均低于超早期(p<0.01),亚急性期FA值低于急性期(p 2、62例无梗塞合并症重型颅脑损伤组:按预后分为两组(预后良好40例,预后不良22例),与对照组比较:预后良好组ADC值在额、内囊、大脑皮质与对照组比较有显著性差异(p < 0.05));预后不良组各感兴趣区ADC值与对照组、预后良好组有差异(p<0.01)。预后不同两组桥脑后部、丘脑、半卵园中心区、内囊后肢、胼胝体压部、额部FA值显著性差异(p<0.05),均低于对照组;白质纤维束三维成像三种形式、体感诱发电位在两组预测准确率均高于GCS评分(p < 0.01).
结论
DWI序列能在早期及时显示外伤性脑梗塞,优于CT及常规MRI序列,DWI比常规T1、T2更真实的反映脑缺血状态,与常规MRI序列联合能辨别出超早期梗塞和晚期梗塞坏死病灶;DWI在明确创伤范围,不可逆损伤程度和远期预后方面有重要作用。DTI作为一种新的MRI成像技术,通过测量脑组织弥散的各向异性程度和空间分布,能够显示脑外伤患者白质纤维束状态,可以客观而定量地评价颅脑损伤患者纤维束的病理改变,对研究脑的显微结构、判断神经功能预后有独特作用。SEPs有助于弥补影像学检查和各种评分量表的不足,分级的SEPs监测脑功能状态敏感、准确,及时灵敏地反映脑损伤缺血后的机能状态,其变化常常出现在GCS和临床症状变化之前,是对大脑和脑干功能量化的评价,可反映脑功能损伤程度。SEPs与DTI联合对判断患者病情、发展变化及预测预后有重要作用。
Objective:
To investigate the quantitative evaluation of MRI diffusion imaging and somatosensory evoked potential for sever trauma brain injury to assess the meaning of illness and prognosis.
Methods
Analysis of the General Hospital of Jinan Military Region neurosurgery in January 2004 ~ May 2008 of 104 cases of inter-hospital patients with severe trauma brain injury (GCS <8 points) of clinical data, Divided into two groups, A group of 42 cases of infarction patients after trauma or injury, another group of 62 cases of severe head injury;Magnetic resonance examination of 20 normal, and patients age, sex matched healthy control group for. All patients underwent head CT、conventional MRI sequences、DWI、DTI.. Infarction after trauma or injury in the infarct group at different times of ultra-early group (<6 hours), sub-acute phase (6 to 24 hours), sub-acute phase group (> 1 ~ 7 days) detection of abnormally high signal-positive cases the number of measuring infarct and contralateral side of ADC values, FA values; 20 normal healthy people, regions of interest were measured: Pons behind、Thalamus、Hyrul,centrum semiovale,the、Posterior limb of internal capsule, Splenium of corpus callosum、The amount of ADC values, FA values; Another group of 62 cases of patients with good prognosis sub-poor prognosis group, more than the same measurement of ADC values from regions of interest, FA values, underwent GCS score、DTI fiber three-dimensional imaging、somatosensory evoked potential examination.
Results
1 After a traumatic injury or infarction group: DWI of the super-acute phase and the acute phase of cerebral infarction were higher than the detection rate of CT, conventional MRI (P <0.05); Conventional MRI, including FLAIR difficult to show that within 6 hours after injury Hyperacute infarct lesion; super-acute phase and the acute phase of infarct ADC values were significantly lower than contralateral (P <0.01);ADC values in the infarct zone increased gradually with the course of disease, the acute stage and ultra-early ADC values was no significant difference (P>O.05), sub-acute phase ADC values higher than the ultra-early , and than the acute phase (P 2 62 cases of severe trauma brain injury: Prognosis of different sub-groups (40 cases of good prognosis, 22 cases of poor prognosis) compared with the control group; Pons behind, thalamus、hyrul,centrum semiovale、posterior limb of internal capsule, splenium of corpus callosum, the amount of FA values were lower than the control group, A good prognosis, regions of interest were the ADC value differences with the control group, mainly in the amount、internal capsule、cerebral cortex; and patients with the amount、gray area at the junction、corpus callosum, brain stem, internal capsule and hyrul,centrum semiovale FA decreased significantly (P <0 .05); Corpus callosum, internal capsule area more obvious (P <0.01); white matter fiber bundles three types of three-dimensional imaging, somatosensory evoked potentials in the prognosis of two different forecasts more accurate than the GCS score (P <0.01).
Conclusion
DWI sequence to show a timely manner at an early stage of cerebral trauma, as early as in the CT and conventional MRI sequences, DWI than conventional T1, T2 is more a reflection of the true state of cerebral ischemia, combined with conventional MRI sequences can identify early and late infarct infarct lesion necrosis;DWI trauma in the scope of discovery, the extent of irreversible injury and long-term prognosis play an important role in, DTI is a new MRI imaging technique, brain tissue by measuring the degree of diffusion anisotropy and spatial distribution, are able to show that patients with traumatic brain white matter fiber bundle, and It can be objective and quantitative evaluation of brain injury in patients with pathological changes in fibers, is in vitro, non-invasive assessment of the value of fiber bundle means of lesions, the study of microstructure of the brain to determine nerve function has a unique role in prognosis. SEPs can help fill the imaging examination and the lack of rating scale that graded the state of brain function monitoring SEPs sensitive, accurate, timely sensitive to ischemic brain damage state after the function, the changes often appear in the GCS and clinical Prior to changes in symptoms, is a quantification of the brain and brainstem function evaluation, Can reflect the degree of cerebral dysfunction, combined with the DTI on patients to determine the development of change and plays an important role in prognosis prediction.
探讨磁共振弥散成像和体感诱发电位对重型颅脑损伤病情及预后评估意义
方法
分析济南军区总医院神经外科和山东省立医院影像研究所2004年1月-2008年5月间收治的重型颅脑损伤患者(GCS<8分)的临床资料,其中42例为外伤或外伤术后合并梗塞患者;无梗塞合并症者62例,另20名行磁共振检查正常、与62病例组年龄、性别相匹配的健康人作对照组。所有患者均行头颅CT、常规MRI序列、DWI、DTI、检查。外伤或外伤术后梗塞组:在梗塞发生后不同时间超早期(< 6小时)、急性期(6-24小时)、亚急性期组(>1-7天)检出异常信号为阳性病例数,测梗塞侧和对侧ADC值、FA值;正常健康人20名,分别测感兴趣区:桥脑后部、丘脑、半卵园中心区、内囊后肢、胼胝体压部、额ADC值、FA值;另一组62例患者,分预后良好、预后不良两组,同样测量以上感兴趣区ADC值、FA值,并行GCS评分、纤维束DTI三维成像、体感诱发电位检查。
结果
1、外伤或外伤术后(合并)梗塞组:DWI对超急性期和急性期脑梗塞的检出率均高于CT、常规MRI (p<0.05);常规MRI包括FLAIR很难显示伤后6小时内超急性期梗塞灶;超急性期和急性期梗塞区ADC值均明显低于对侧(p<0.01),在梗塞区ADC值随病程逐渐升高,急性期和超早期ADC值无显著差异(p>O.05),亚急性期ADC值高于超早期、急性期(p <0.01);在急性期和亚急性期的梗塞区FA值均随着病程进展逐渐降低,急性期和亚急性期FA值均低于超早期(p<0.01),亚急性期FA值低于急性期(p
结论
DWI序列能在早期及时显示外伤性脑梗塞,优于CT及常规MRI序列,DWI比常规T1、T2更真实的反映脑缺血状态,与常规MRI序列联合能辨别出超早期梗塞和晚期梗塞坏死病灶;DWI在明确创伤范围,不可逆损伤程度和远期预后方面有重要作用。DTI作为一种新的MRI成像技术,通过测量脑组织弥散的各向异性程度和空间分布,能够显示脑外伤患者白质纤维束状态,可以客观而定量地评价颅脑损伤患者纤维束的病理改变,对研究脑的显微结构、判断神经功能预后有独特作用。SEPs有助于弥补影像学检查和各种评分量表的不足,分级的SEPs监测脑功能状态敏感、准确,及时灵敏地反映脑损伤缺血后的机能状态,其变化常常出现在GCS和临床症状变化之前,是对大脑和脑干功能量化的评价,可反映脑功能损伤程度。SEPs与DTI联合对判断患者病情、发展变化及预测预后有重要作用。
Objective:
To investigate the quantitative evaluation of MRI diffusion imaging and somatosensory evoked potential for sever trauma brain injury to assess the meaning of illness and prognosis.
Methods
Analysis of the General Hospital of Jinan Military Region neurosurgery in January 2004 ~ May 2008 of 104 cases of inter-hospital patients with severe trauma brain injury (GCS <8 points) of clinical data, Divided into two groups, A group of 42 cases of infarction patients after trauma or injury, another group of 62 cases of severe head injury;Magnetic resonance examination of 20 normal, and patients age, sex matched healthy control group for. All patients underwent head CT、conventional MRI sequences、DWI、DTI.. Infarction after trauma or injury in the infarct group at different times of ultra-early group (<6 hours), sub-acute phase (6 to 24 hours), sub-acute phase group (> 1 ~ 7 days) detection of abnormally high signal-positive cases the number of measuring infarct and contralateral side of ADC values, FA values; 20 normal healthy people, regions of interest were measured: Pons behind、Thalamus、Hyrul,centrum semiovale,the、Posterior limb of internal capsule, Splenium of corpus callosum、The amount of ADC values, FA values; Another group of 62 cases of patients with good prognosis sub-poor prognosis group, more than the same measurement of ADC values from regions of interest, FA values, underwent GCS score、DTI fiber three-dimensional imaging、somatosensory evoked potential examination.
Results
1 After a traumatic injury or infarction group: DWI of the super-acute phase and the acute phase of cerebral infarction were higher than the detection rate of CT, conventional MRI (P <0.05); Conventional MRI, including FLAIR difficult to show that within 6 hours after injury Hyperacute infarct lesion; super-acute phase and the acute phase of infarct ADC values were significantly lower than contralateral (P <0.01);ADC values in the infarct zone increased gradually with the course of disease, the acute stage and ultra-early ADC values was no significant difference (P>O.05), sub-acute phase ADC values higher than the ultra-early , and than the acute phase (P
Conclusion
DWI sequence to show a timely manner at an early stage of cerebral trauma, as early as in the CT and conventional MRI sequences, DWI than conventional T1, T2 is more a reflection of the true state of cerebral ischemia, combined with conventional MRI sequences can identify early and late infarct infarct lesion necrosis;DWI trauma in the scope of discovery, the extent of irreversible injury and long-term prognosis play an important role in, DTI is a new MRI imaging technique, brain tissue by measuring the degree of diffusion anisotropy and spatial distribution, are able to show that patients with traumatic brain white matter fiber bundle, and It can be objective and quantitative evaluation of brain injury in patients with pathological changes in fibers, is in vitro, non-invasive assessment of the value of fiber bundle means of lesions, the study of microstructure of the brain to determine nerve function has a unique role in prognosis. SEPs can help fill the imaging examination and the lack of rating scale that graded the state of brain function monitoring SEPs sensitive, accurate, timely sensitive to ischemic brain damage state after the function, the changes often appear in the GCS and clinical Prior to changes in symptoms, is a quantification of the brain and brainstem function evaluation, Can reflect the degree of cerebral dysfunction, combined with the DTI on patients to determine the development of change and plays an important role in prognosis prediction.
引文
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