重型颅脑创伤长期意识障碍患者清醒预测的MRI分级研究

目的 探讨MRI对重型颅腩创伤后长期意识障碍患者清醒预测的分级标准.方法 记录66例重型TBI意识障碍超过2周患者的MRI表现,以MRI的表现分为3级:Ⅰ级:仅有大脑半球的损伤;Ⅱ级:丘脑、胼胝体的损伤,伴或不伴有I级的损伤灶,包括:Ⅱa级(单侧丘脑的损伤)和Ⅱb级(胼胝体、双侧丘脑的损伤);Ⅲ级:脑干背外侧的损伤,伴或小伴有Ⅰ级和(或)Ⅱ级的损伤灶.预后以颅脑创伤后6个月患者是否清醒为标准.结果 MRI分级与清醒的概率有显著相关性,Pearson相关系数-0.722(P＜0.05),分级越高,预后越差;Ⅱb级、Ⅲ级作为预后不良的指标,判断的敏感性为85.7%,特异性为87.5%,准确率为86.4%,错误率为13.6%;ROC曲线下面积为0.89,95%可信区间为(0.808,0.978).结论 MRI分级可客观、准确地反映颅脑创伤程度和清醒的概率.

Magnetic resonance imaging grading in prediction of outcome of awakening in long-term consciousness disorders patients after severe traumatic brain injury

Objective To explore the magnetic resonance imaging(MRI) grading in long- term consciousness disorders patients after severe traumatic brain injury (TBI) considering awakening.Method MRIs were recorded and analyzed in 66 patients suffering from severe TBI with duration of consciousness disorders ≥2 weeks.MRIs were classified as following grading facters:Grade Ⅰ:lesions were localized within hemispheres; Grade Ⅱ:lesions were localized in thalamus and/or corpus callosum with or without lesions of grade Ⅰ ; Grade Ⅱ a:lesions were localized within unilateral thalamus; Grade Ⅱ b:lesions were localized in corpus callosum and/or bilateral thalamus;Grade Ⅲ: lesions were localoized in dorsolateral brainstem with or without lesions of grade Ⅰ and/or grade Ⅱ.The awakening after sixth months was used as the criterion.ResultsMRI grading had significant correlation with the probability of awakening.The Pearson's Correlation was -0.722(P ＜0.05).The higher the MRI grades,the lower the probability of awakening.Grade Ⅱb and Ⅲ could be used as indicators of poor prognosis.The sensitivity was 85.7%,specificity 87.5%,accuracy 86.4% and error rate 13.6%.The area under ROC curve was 0.89 and 95% confidence interval was from 0.808 to 0.978.Conclusions MRI grading could demonstrate cerebral dysfunction and probability of patients' awakening objectively and accurately.