摘要
目的:采用MRI 3种成像序列量化弥漫性轴索损伤(DAI)病灶,并建立MRI病理分级标准,评估该分级标准与病灶部位长期预后的相关性.方法:前瞻性研究30例经MRI和CT确诊的重度DAI患者.采用DWI、T2加权梯度回波成像以及SWI,对照Adams分级,建立MRI分级标准.治疗6个月后,使用扩展格拉斯哥结局量表评估临床结果.结果:DWI可定位丘脑、基底结节及内囊病灶,SWI可定位黑质和中脑病灶.单因素分析显示,年龄、入院与出院时格拉斯哥运动评分、黑质和中脑盖、中脑顶盖和背侧脑桥出血病灶及丘脑病灶均与长期不良预后显著相关(均P<0.05).多因素分析显示,≥30岁、中脑病灶、黑质病灶及丘脑病灶均与不良预后相关.结论:≥30岁、黑质病灶及中脑被盖病灶与DAI的不良预后相关.MRI分级标准分为4级:Ⅰ级脑半球病灶,Ⅱ级胼胝体病灶,Ⅲ级脑干病灶,Ⅳ级黑质或中脑被盖病灶),可用于DAI的长期预后评估.
Objective:Three MRI sequences were used to quantify the anatomical distribution of diffuse axonal injury (DAI) lesions, to grade DAI according to the Adams grading system, and to evaluate the value of lesion localization in combination with clinical prognostic factors to improve outcome prediction. Methods: Thirty patients with severe DAI examined with MRI within 1 week post-inj ury were included. DWI, T2*GRE and SWI sequences were used. Extended Glasgow Outcome Score was assessed after 6 months. Results: DWI showed lesions in the thalamus, basal ganglia and internal capsule and SWI showed lesions in the mesencephalon and substantia nigra. The single factor analysis revealed that age, Glasgow Motor Score (GMS) at admission, GMS at diacharge, the bleeding lesions in the substantia nigra, the mesencephalic tegmental and tectum, the pons and lesions in the thalamus had significant correlations. Multivariate analysis revealed an independent relation with poor outcome for age and lesions in the mesencephalic region, substantia nigra and thalamus. Conclusions: We conclude that higher age and lesions in substantia nigra and mesencephalic tegmentum indicate poor long-term outcome in DAI. We propose an extended MRI classification system based on four stages, Stage Ⅰ for hemispheric lesions, Stage Ⅱ for corpus callosum lesions, Stage Ⅲ for brainstem lesions, and Stage Ⅳ for substantia nigra or mesencephalic tegmentum lesions, which can be used to evaluate long-term prognosis.
作者
谢鹏
董鑫
汪军
江广斌
蔡守国
Xie Peng;Dong Xin;Wang Jun;Jiang Guangbin;Cai Shouguo(Department of Medical Imaging, Suizhou Hospital Affiliated of Hubei University of Medicine, Suizhou, 441300, China)
出处
《中国中西医结合影像学杂志》
2019年第4期351-355,共5页
Chinese Imaging Journal of Integrated Traditional and Western Medicine
关键词
成年人
脑损伤
弥漫性轴索损伤
磁共振成像
敏感加权成像
Adult
Brain injuries
Diffuse axonal injury
Magnetic resonance imaging
Susceptibility weighted imaging
