创伤性癫痫动物模型的研究进展

创伤性脑损伤（traumatic brain injury，TBI）非常常见。在美国，每29s即出现1例TBI患者，每年有150万TBI患者，其中23万人住院和生存，8万人出院时有不同程度的TBI相关性残疾，5万人死亡。TBI为40岁以下人群致死和致残的主要原因，有530万美国人有TBI相关性残疾。因此，TBI一直是神经外科领域研究的重要课题。TBI原因有多种，病理类型多变，临床结局多样。其中创伤性癫痫（posttraumatic epilepsy．     

脑卒中五年生存的队列研究

目的对脑卒中进行生存描述，分析影响其预后的相关因素。方法前瞻性研究143例脑卒中患者，随访5年，Life—Table法、Kaplan—Meier法进行生存分析，Cox比例风险模型筛选影响预后的显著因素。结果（1）1个月、2个月、3个月、6个月、1年、3年、5年累积生存率分剐是79．0％、77．0％、76．0％、73．0％、70．0％、63．0％和51％，以发病第1个月死亡风险最高；（2）单因素Cox比例风险分析显示：年龄（RR=1．728），人均收入（RR=0．636），高血压史（RR=1．428），脑卒中部位（RR=0．463），脑损伤体积（RR=2．134），脑组织移位（RR=3．445），出院时情况（RR=3．353），后遗症（RR=2．622）坚持出院后规范治疗（RR=0．462），出院后锻炼情况（RR=0．583），再次复发（RR=3．912），对康复的信心（RR=1．799），应激事件（RR=1．933），社会家庭支持（RR=0．381）与患者生存相关；（3）多因素Cox比例风险分析进入模型的因素是：年龄、脑组织移位、再次复发、出院时情况、社会家庭支持；（4）死亡风险函数h（t）=h0（t）exp（0．459×年龄＋0．650×脑组织移位＋0．773×再次复发＋0．653×出院时情况-0．552×社会家庭支持）。结论脑卒中预后多为不良，发病第1个月内死亡风险最高，年龄、脑组织移位、再次复发、出院时情况、社会家庭支持是影响预后的独立因素，院内规范化治疗，改善残障程度，社会家庭支持，预防再次复发对改善很有裨益。     

急性脑出血早发癫痫临床观察

目的：探讨急性脑出血早发癫痫对预后的影响。方法：对328例急性脑出血中60例早发癫痫患者临床资料进行回顾性分析。结果：早发癫痫与脑出血的部位有关，以脑叶出血发生率高，发作类型以部分性发作多见，早发癫痫的脑出血病死率31．0％，而无癫痫发作的脑出血病死率为12．0%，两者有非常显著差异（P〈0．01），急性脑出血有无早发癫痫还影响致残和生存质量下降（P〈0．01）。结论：急性脑出血继发癫痫，特别是早发癫痫者对预后有显著影响，在治疗脑出血同时应进行抗癫痫治疗，采取更积极方法以降低病死率、致残率。     

创伤性脑损伤术后迟发性血肿的临床分析

目的探讨创伤性脑损伤（traumatic brain injury，TBI）开颅术后迟发性血肿诊断和治疗。方法对我院52例TBI患者开颅术后迟发性血肿的临床资料进行回顾性分析和总结。结果患者出院时GOS评分：Ⅰ级11例，Ⅱ级9例，Ⅲ级12例，Ⅳ级11例，Ⅴ级9例。结论TBI术后发生DTICH患者的预后取决于早期发现，及早治疗。     

解放军总医院呼吸科监护室住院患者死亡规律分析

目的：通过回顾性分析解放军总医院呼吸科监护室1495例住院患者中253例死亡特点、不同影响因素死亡风险及死亡时间规律,寻找工作弱点,以期提高工作质量,降低死亡率。方法从医院信息系统（ HIS）中提取住院患者资料,按照不同时间划分方法进行分类统计。结果每年11月至次年3月死亡率高于其他月份,为19．5％（P＜0．05）。8∶01～9∶00及23∶01～24∶00入院死亡率高（P＜0．05）,分别为41．7％和50．0％。周内各天死亡率差异有统计学意义（P＜0．01）,周六死亡率最高,为43．1％。0∶01～1∶00、4∶01～5∶00、9∶01～10∶00、13∶01～14∶00死亡构成比较大（P＜0．05）,分别为7．1％、7．1％、6．7％、6．7％。非工作日死亡率（38．3％）高于工作日死亡率13．2％（P＜0．01）。非工作时间死亡率（31．3％）高于工作时间（工作日8∶00～11∶30,14∶30～18∶00）死亡率（5．2％,P＜0．01）。 Logistic回归分析提示,年龄、入院月份、出院时间是否为工作时间对预后的影响差异有统计学意义（P＜0．05）,OR值分别为1．06、1．07、0．08。结论每年11月至次年3月死亡率高,与冬季呼吸系统疾病高发,寒冷天气使得机体循环阻力增大,调节失衡及大气污染相关。年龄因素、入院月份、出院时间是否在工作时间与预后相关。死亡率与医护人员工作结构明显相关,因此,提高医护人员工作质量,合理安排医护力量,对于改善患者预后,降低死亡率有很大作用。     

喉鳞状细胞癌中C-erbB-2和E-钙粘附素蛋白表达及其意义

目的：探讨癌基因c—erbB-2蛋白和黏附分子E-钙黏蛋白（E—cad）表达与喉鳞状细胞癌（LSCC）的发生、发展和生物学意义。方法：应用免疫组织化学方法，检测45例LSCC组织和15例声带息肉（VCP）组织中c—erbB-2和E—cad蚤白表达水平。结果：在LSCC组织中c—erbB-2和E—cad表达阳性率分别为75．6%（34／45）和62．2％（28／45）。LSCC中，c—erbB-2表达阳性率高于VCP（0／15，0．0%,40，X^2=22．12，P＜0．01），而E—cad表达阳性率低于VCP（15／15，100％，X^2=4．73，P〈0．05）。c—erbB-2高表达和E—cad低表达与LSCC分级和淋巴结转移相关（P〈0．05）。LSCC中c—erbB-2表达与E—cad表达呈负相关（r=-0．30）。结论：c—erbB-2和E—cad表达水平可作为判断LSCC分级和淋巴结转移和预后的重要参考指标。     

强化健康教育对老年心力衰竭患者近期预后的影响研究

目的探讨强化健康教育对老年心力衰竭患者近期预后的影响。方法将125例老年心力衰竭患者随机分为常规组和强化组。强化组在常规健康教育基础上加强了心力衰竭诱因的控制、家属教育、服药依从性、出院指导及就诊指导方面的内容，并对教育效果进行评估。观察比较出院后6个月内再入院率及死亡率。结果出院评估和随访评估显示强化组的健康教育效果明显优于常规组；强化组6个月内再入院率（24．2％ vs 48．3％，P〈0．01）和死亡率（8．1％ vs 13．8％，P〈0．05）显著低于常规组。结论强化健康教育有助于改善老年心力衰竭患者近期预后。     

18F-FDG符合线路显像评价非霍奇金淋巴瘤早期疗效及预后

目的探讨^18F-脱氧葡萄糖（FDG）符合线路显像在评价非霍奇金淋巴瘤（NHL）早期疗效和预后中的价值。方法48例经病理检查证实为NHL的患者在化疗早期（2～5个疗程后）行^18F—FDG符合线路显像，将患者分为2组：第1组显像阳性（23例），第2组显像阴性（25例）。对2组患者早期疗效行临床评估，用Kaplan—Meier单因素分析法行患者无进展生存期（PFS）分析，并对影响PFS与预后的因素行Cox回归分析。结果（1）第1组完全缓解1例，部分缓解6例，未缓解5例，进展11例；第2组完全缓解20例，部分缓解4例，进展1例。显像改变了21％（10／48）患者的治疗方案。（2）Kap—lan—Meier单因素分析示，第1组患者2年无进展生存率为12．8％，第2组为78．0％；^18F—FDG显像阳性与阴性的病例其PFS差异有统计学意义（P〈0．0001）。Cox回归分析示^18F—FDG显像对预测PFS的作用具有统计学意义（P〈0．001），且独立于其他变量。（3）显像与X线胸片、CT、MRI、B超等同期检查比较，两者评估准确性分别为85．4％、66．7％，阳性预测值为91．3％、68．0％。结论^18F—FDG符合线路显像对评估NHL早期治疗反应与预后均有重要作用。     

核素心室显像对急性心肌梗塞远期预后的预测价值

目的：探讨平衡法核素心室显像（ＥＲＮＶ）对急性心肌梗塞（ＡＭＩ）远期预后的预测价值。方法：对８９例于发病后４—６周行ＥＲＮＶ检查的ＡＭＩ患者进行了２３（１２—４２）个月的随访。参照病人预后，将其分为２组：第一组为出院后出现心脏猝死（ＳＣＤ）和（或）心力衰竭（ＮＦ）者（ｎ＝２０）；第二组为出院后无心脏事件者（ｎ＝６９）。并按年龄、性别进行１：２配对。对可能影响其远期预后的１７个参数进行了分析。结果：ＳＣＤ发生率为２．２％；去除年龄及性别因素，左室侧壁射血分数（ＬＡＴ－ＥＦ）、血清肌酸磷酸激酶同工酶（ＣＫ－ＭＢ）是判断ＡＭＩ远期预后的独立有效的危险因子；建立了一预后指数公式：Ｚ＝２．４７６（ＬＡＴ－ＥＦ）＋０．７６０（ＣＫ－ＭＢ），Ｚ越大，ＳＣＤ或ＨＦ发生率越高。结论：ＥＲＮＶ在ＡＭＩ远期预后的预测中有重要作用。     

新生儿缺氧缺血性脑病的MR波谱研究

目的观察足月新生儿缺氧缺血性脑病（HIE）时的脑代谢改变，并探讨其与临床分度及预后的关系。方法以9例无窒息的正常新生儿作为对照，对临床确诊的46例HIE患儿进行MRI及氢质子MR波谱（^1H—MRS）检查，MRS采用单体素及二维多体素化学位移波谱技术。46例HIE临床分度包括轻度25例、中度11例以及重度10例。观察HIE患儿MRS代谢物变化及其与临床分度和预后的关系。结果（1）HIE的典型表现为：乳酸（Lac）峰增高，谷氨酸及谷氨酰复合物α峰（GLx—α）增高及氮-乙酰天门冬氨酸（NAA）峰降低。（2）GLx—α／肌酸及磷酸肌酸（Cr）比值在对照组及HIE轻、中、重度组分别为0．16、0．21、0．64、1．31，GLx—α／Cr比值在对照组及HIE组差异有统计学意义（t=5．01，P〈0．01），且在HIE各组之间差异亦有统计学意义（F=63．29，P〈0．05）。Lac／Cr比值在对照组及HIE轻、中、重度组分别为0．12、0．14、0．19、0．26，该比值在对照组及HIE组差异有统计学意义（t=2．78，P〈0．05），且在HIE各组之间差异亦有统计学意义（F=11．74，P〈0．05）。GLx—α／Cr及Lac／Cr比值与临床分度呈正相关性（r=0．76及0．59，P均〈0．01）。NAA／Cr比值在HIE重度组明显低于中、轻度组。（3）等级相关分析证明GLx—α／Cr及Lac／Cr比值与HIE预后呈负相关关系，尤其是GLx—α／Cr比值相关性更强（相关系数r=-0．83，P〈0．01），可作为评估HIE预后的有效指标。结论 ^1H—MRS技术可无创观察HIE患儿脑代谢改变，观察脑损伤严重程度及预后评估。HIE患儿基底节区GLx—α／Cr比值升高提示预后不良。     

重型颅脑损伤后长期意识障碍患者体感诱发电位分级与生存质量的关系

目的 分析重型颅脑损伤后长期意识障碍患者的生存质量及体感诱发电位(SEP)分级. 方法 对47例重度颅脑损伤后意识障碍超过2周的患者进行清醒预测,选择5个预后因子即年龄、性别、受伤机制、去骨瓣减压手术、SEP表现方式对预后进行分析.生存质量以6个月后格拉斯哥预后评分(GOS)为标准进行判别. 结果 患者预后状态与SEP分级有明显相关性(P=0.024).SEP对预后的预测准确率为91.5%.患者的SEP分级为Ⅰ级时,44%(7/16)的患者预后良好;若患者的SEP分级为Ⅱ～Ⅲ级,则95%～100%的患者预后为重残、植物状态或死亡.结论 SEP分级可客观、准确地评估患者的预后及反映脑功能状态.     

Does distracting pain justify performing brain computed tomography in multiple traumas with mild head injury?

Traumatic brain injury (TBI) is a significant health concern classified as mild, moderate, and severe. Although the indications to perform brain computed tomography (CT) are clear in moderate and severe cases, there still exists controversy in mild TBI (mTBI). We designed the study to evaluate the significance of distracting pain in patients with mTBI. The study population included patients with mild traumatic brain injury (GCS ≥13). Moderate and high risk factors including age <18 months or ≥60 years, moderate to severe or progressive headache, ≥2 episodes of vomiting, loss of consciousness (LOC), post-traumatic amnesia, seizure or prior antiepileptic use, alcohol intoxication, previous neurosurgical procedures, uncontrolled hypertension, anticoagulant use, presence of focal neurologic deficits, deformities in craniofacial region, and penetrating injuries were excluded. The patients were then grouped based on presence (DP+) or absence (DP?) of another organ fracture with severe pain (based on VAS). The primary outcome was any abnormal findings on brain CT scans; 330 patients were enrolled (184 DP+ and 146 DP?). Overall, two DP+ and one DP? patients had mild cerebral edema in brain CT (p?>?0.99). No patients had any neurologic symptoms or signs in follow-up. Our results show that in the absence of any other risk factors, distracting pain from other organs (limbs, pelvis, and non-cervical spine) cannot be regarded as a brain CT indication in patients with mild TBI, as it is never associated with significant intracranial lesions.     

脑外伤患者血浆抵抗素浓度的变化

目的 揭示脑外伤患者血浆抵抗素浓度的变化,探讨其在脑损伤中的作用及对预后的预测价值.方法收集中型脑外伤54例,重型脑外伤71例,健康体检人群40例(对照组).对照组静脉血体检时获得;脑外伤患者静脉血在入院时获得.酶联免疫吸附试验测定血浆抵抗素浓度.结果脑外伤后3个月,中型和重型脑外伤患者预后不良(GOS 1～3分)20例(37.0%)和53例(74.6%).经协方差分析,中型和重型脑外伤患者血浆抵抗素浓度(21.9 ±8.4)ng/ml和(29.2±9.6)ng/ml,均显著高于对照组(9.3±2.6)ng/ml(P＜0.01).经多元线性回归分析,中型和重型脑外伤患者血浆抵抗素浓度与入院时GCS评分(t=3.120,P=0.007;t=3.986,P=0.003)和血浆C-反应蛋白浓度(t=2.212,P=0.035;t=2.274,P=0.014)均显著相关.Logistic回归分析显示,入院时血浆抵抗素浓度显著升高(OR=1.124,95%CI=1.040～1.221,P=0.011;OR=1.145,95%CI=1.044～1.232,P=0.009)是中型和重型脑外伤预后不良的危险因素.受试者工作特征曲线分析显示,血浆抵抗素浓度预测中型和重型脑外伤后3个月预后不良均有显著预测价值(AUC=0.719,95%CI=0.642～0.829,P=0.000;AUC=0.735,95%CI=0.671～0.893,P=0.000),且判定血浆抵抗素浓度22.4 ng/ml和30.5 ng/ml,对预测中型和重型脑外伤后3个月预后不良有70.0%和79.2%的灵敏度和70.6%和72.2%的特异度.结论 脑外伤后血浆抵抗素浓度升高,可能参与脑损伤的炎症反应,临床检测这个指标有助于早期判断脑外伤患者的预后.

Abstract：

Objective To determine plasma resistin level in patients with traumatic brain injury (TBI) and evaluate its correlations with outcome and inflammatory reaction. Methods Fiftyfour patients with moderate TBI, 71 patients with severe TBI and 40 healthy controls were enrolled in this study. Plasma samples were obtained from the healthy controls on physical examination and from the TBI patients on admission. Enzyme-linked immunosorbent assay ( ELISA) was used to determine the plasma resistin concentrations. Results Twenty patients (37.0% ) and 53 patients (74.6% ) with moderate and severe TBI suffered from an unfavorable outcome (defined as GOS score for 1-3 points) three months after TBI respectively. Plasma resistin levels in the patients with moderate and severe TBI were substantially higher than that in the healthy controls ((21. 9 ± 8. 4) ng/ml and (29. 2 ± 9. 6) ng/ml vs (9. 3 ± 2.6) ng/ml, both P ＜0. 01] by using covariance analysis. By using the multivariate linear regression analysis, plasma C-reactive protein level (t =2.212,P =0.035; t =2. 274,P =0. 014) and GCS scores (t =3. 120,P =0.007; t=3.986,P=0.003) were associated with the plasma resistin levels. Logistic regression analysis selected plasma resistin level as an independent predictor for 3-month unfavorable outcome of the patients with moderate and severe TBI (odds ratio = 1. 124, 95% CI = 1. 040-1. 221, P = 0.011; odds ratio = 1. 145, 95% CI = 1. 044-1. 232, P = 0. 009). A receiver operating characteristic curve identified cutoff levels of plasma resistin (22.4 ng/ml and 30.5 ng/ml) that predicted 3-month unfavorable outcome of moderate and severe TBI patients with the high sensitivity (70. 0% and 79. 2% ) and specificity (70.6% and 72.2% ) ( area under curve = 0.719, 95% CI = 0.642-0.829, P = 0.000;area under curve =0.735, 95% CI =0. 671-0. 893, P = 0.000). Conclusions Plasma resistin level is increased after TBI and may be involved in inflammatory response of brain injury. Clinical detection of this indicator can help early determine the prognosis of the TBI patients.     

标准大骨瓣减压并侧脑室颞角开放治疗重型创伤性颅脑损伤85例疗效分析

目的探讨标准大骨瓣减压并同侧脑室颞角开放治疗重型颅脑损伤的疗效。方法回顾性分析我院2003年7月~2013年7月收治的245例重型颅脑损伤行标准大骨瓣减压患者,其中标准大骨瓣减压并颅内血肿清除或额极颞极切除及侧脑室颞角开放85例(A组),标准大骨瓣减压并颅内血肿清除或额极颞极切除90例(B组),单纯标准大骨瓣减压70例(C组)。记录所有患者的性别、年龄、术前格拉斯哥昏迷评分(GCS)、受伤至手术的时间、瞳孔大小、CT表现、血压、动脉血氧分压、血糖等临床资料和6个月后的格拉斯哥预后评分(GOS)。根据GOS分级,比较A、B、C三组之间6个月后的疗效。结果 A、B、C三组存活者6个月后GOS良好或轻-中度残疾的比率分别是23.5%、20.0%、20.0%,GOS重度残疾或植物生存的比率分别是50.6%、47.8%、40.0%,A、B、C三组的死亡率分别是25.9%、32.2%、40.0%。运用SPSS 15.0统计软件,经Ridit分析显示:F=3.37,P=0.0371。结论对于重型颅脑损伤,在降低死亡率方面,标准大骨瓣减压并颅内血肿清除或额极颞极切除及侧脑室颞角开放优于标准大骨瓣减压并颅内血肿清除或额极颞极切除和单纯标准大骨瓣减压,但没有明显提高6个月后良好或轻-中度残疾的比率。     

格拉斯哥记分3～5颅脑创伤的临床救治及探讨

目的：探讨特重型（CCS3～5）颅脑伤患者的救治策略，并分析相关因素。方法：对156例患者进行综合治疗，注重伤后救治的连续性、各个治疗环节的衔接、以及并发症防治。强凋早期足量应用甘露醇和手术指征的选择。结果：死亡率为42．3％（66／156）。存活患者按COS评分，恢复良好13例（14．4％）。中度残废32例（35．6％），重度残废40例（44．4％），持续植物生存5例（5．6％）。结论：严格按照综合治疗原则实施，可在一定程度上降低特重型颅脑损伤的死亡率。     

Proton MR spectroscopic imaging depicts diffuse axonal injury in children with traumatic brain injury

BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) after traumatic brain injury (TBI) is important in patient assessment and prognosis, yet they are underestimated with conventional imaging techniques. We used MR spectroscopic imaging (MRSI) to detect DAI and determine whether metabolite ratios are accurate in predicting long-term outcomes and to examine regional differences in injury between children with TBI and control subjects. METHODS: Forty children with TBI underwent transverse proton MRSI through the level of the corpus callosum within 1-16 days after injury. T2-weighted, fluid-attenuated inversion recovery, and susceptibility-weighted MR imaging was used to identify voxels as normal-appearing or as nonhemorrhagic or hemorrhagic injury. Neurologic outcome was evaluated at 6-12 months after injury. Metabolite ratios for total (all voxels), normal-appearing, and hemorrhagic brain were compared and used in a logistic regression model to predict long-term outcome. Total and regional metabolite ratios were compared with control data. RESULTS: A significant decrease in N-acetylaspartate (NAA)/creatine (Cr) and increase in choline (Cho)/Cr (evidence of DAI) was observed in normal-appearing (P < .05) and visibly injured (hemorrhagic) brain (P < .001) compared with controls. In normal-appearing brain NAA/Cr decreased more in patients with poor outcomes (1.32 +/- 0.54) than in those with good outcomes (1.61 +/- 0.50, P = .01) or control subjects (1.86 +/- 0.1, P = .00). In visibly injured brains, ratios were similarly altered in all patients. In predicting outcomes, ratios from normal-appearing and visibly-injured brain were 85% and 67% accurate, respectively. CONCLUSION: MRSI can depict injury in brain that appears normal on imaging and is useful for predicting long-term outcomes.     

脑弥漫性轴索损伤125例临床分析

目的探讨脑弥漫性轴索损伤的发病机制、临床特点、诊断、治疗和预后。方法回顾性分析125例脑弥漫性轴索损伤患者的临床资料。结果伤后6个月根据格拉斯哥预后分级:恢复良好28例(22.4%)、中残32例(25.6%)、重残30例(24%)、植物生存11例(8.8%)、死亡24例(19.2%)。结论脑弥漫性轴索损伤是重型颅脑损伤患者死亡的主要原因,致残率高;意识障碍是其典型临床表现。其诊断MRI检查优于CT;大部分采取非手术治疗。格拉斯哥昏迷评分越低,患者昏迷持续时间越长,预后越差。     

道路交通伤中特重型颅脑损伤的救治新策略

目的探讨道路交通伤中特重型颅脑损伤患者的伤情特点及救治新策略。方法对我院自2005年5月—2011年5月采用综合治疗资料完整的86例由交通事故导致的特重型颅脑损伤患者进行分析,其中高速公路组29例,普通公路组57例,并对高速公路和普通公路发生的特重型颅脑损伤患者进行对比分析。结果高速公路组29例,死亡13例,死亡率为44.8%;生存者按格拉斯哥预后评分(GOS),恢复良好4例(13.8%),中残3例(10.3%),重残5例(17.2%),植物生存4例(13.8%)。普通公路组57例,死亡40例,死亡率为70.2%;恢复良好7例(12.3%),中残5例(8.8%),重残3例(5.2%),植物生存2例(3.5%)。结论高速公路伤员多为男性青壮年,送院时间较长,多发伤比例高,休克发生率高,评分3分患者极难生存。但院前急救为特重型颅脑损伤患者抢救赢得了时间,对于提高生存率与生存质量,改善预后具有重大意义。     

Occipital condyle fractures: incidence and clinical follow-up at a level 1 trauma centre

The purpose of the study was to investigate the incidence, management, and outcomes of occipital condyle fractures at a level 1 trauma center. Blunt trauma patients with occipital condyle fracture admitted to a level 1 trauma center over a 3-year period were identified. Prospective clinical and functional follow-up was undertaken, including further radiographic imaging. The incidence of occipital condyle fracture in patients presenting to our level 1 trauma center was 1.7/1,000 per year. Twenty-four patients were followed up at a mean of 27 months post-injury. There was one case of isolated occipital condyle fracture; all other patients had sustained additional orthopedic, cervical spine, and/or head injury. Seven (29%) patients sustained unilateral Type III avulsion fractures, none of which were isolated injuries. Traumatic brain injury was detected in 46% of study patients, and 42% had cervical spine injury. External halothoracic immobilization was used in 33% of cases. Fracture union with anatomical alignment occurred in 21 patients (88%). No patient had cranial nerve deficit at admission or follow-up. Three patients (12.5%) had moderate to severe neck pain/disability at follow-up, all of whom had sustained multiple injuries. Occipital condyle fractures most frequently occur in conjunction with additional injuries, particularly head and cervical spine injuries. Most cases can be managed successfully nonoperatively. Functional outcome is generally determined by pain and disability related to other injuries, rather than occipital fracture configuration. Presented at the 57th Annual Scientific Meeting of the Royal Australian and New Zealand College of Radiologists, Christchurch, New Zealand, October 27–29th 2006.     

Prospective longitudinal proton magnetic resonance spectroscopic imaging in adult traumatic brain injury

PURPOSE: To investigate whether longitudinal magnetic resonance proton spectroscopic imaging (MRSI) demonstrates regional metabolite abnormalities after traumatic brain injury (TBI) that predict long-term neurologic outcome. MATERIALS AND METHODS: Two-dimensional-MRSI (point resolved spectroscopy sequence [PRESS]; TR/TE = 3000/144 msec; 10 mm) was acquired prospectively in 42 adults with severe TBI through the level of the corpus callosum 7 +/- 4 days after injury. Measurements were repeated in 31 patients six to 12 months after injury. Regional and pooled (all regions combined) mean ratios were compared with control values and then used to predict long-term (six- to -12-month) neurologic outcome (good vs. poor) using a logistic regression model. RESULTS: Initial pooled mean N-acetylaspartate (NAA) ratios were lower (P < 0.01) and choline (Cho)/creatine (Cr) ratios higher (P < 0.01) in all TBI patients compared to controls. Ratios from the corpus callosum region were affected most and predicted long-term dichotomized outcome with 83% accuracy. When repeated at six to 12 months after injury, pooled mean NAA/Cr remained lower (P = 0.03) and Cho/Cr remained higher (P = 0.01) in patients with poor outcomes. CONCLUSION: The NAA/Cr ratio from the corpus callosum was most useful for outcome prediction. Chronic alterations of metabolite ratios are likely due to neuronal loss and glial proliferation long after injury.