重型颅脑损伤长期意识障碍患者MRI表现与预后的关系

目的 探讨重型颅脑损伤长期意识障碍患者磁共振成像(MRI)表现与预后的关系.方法 收集珠江医院神经外科自2003年1月至2008年8月收治的66例重型颅脑损伤后意识障碍超过2周的患者的头部MRI资料,统计MRI横断位扫描T2WI像中脑干、丘脑、基底前脑、胼胝体、大脑皮层下及大脑皮层等区域的异常信号表现,以颅脑损伤后6个月患者是否清醒分为清醒组与非清醒组,运用Logistic回归分析计算患者头部MRI中的损伤灶位置与清醒与否的OR值,明确对预后有影响的独立危险因素.结果 头颅MRI中脑干腹侧及背侧、双侧基底前脑、双侧丘脑、胼胝体、双侧大脑额叶区域损伤和未损伤患者在清醒组与非清醒组间比较差异有统计学意义(P<0.05).Logistic回归分析显示脑干背侧损伤、丘脑右侧损伤、胼胝体损伤是影响预后的独立危险因素.结论 MRI表现可较客观、准确地反映脑损伤程度和预测患者的预后,脑干中上段背侧、胼胝体、丘脑有损伤灶的患者预示着难以清醒.

Correlation between magnetic resonance imaging manifestations and prognosis in long-term consciousness disorder patients with severe traumatic brain injury

Objective To explore the correlation between magnetic resonance imaging(MRI)manifestations and the prognosis in long-term consciousness disorder patients with severe traumatic brain injury(TBI).Methods MRI data were collected in 66 patients with a duration of disturbance of unconsciousness for more than 2 weeks.These patients suffered from severe TBI and were admitted to our hospital from January 2003 to August 2008.The data about regions of abnormal signal in T2WI in the brain stem,the thalamus,the basal forebrain,the corpus callosum,the cerebral cortex and the subcortical area were recorded and analyzed.The patients were divided into conscious and unconscious groups based on the outcome 6 months after the injury.Logistic regression analysis was used to calculate the OR value between the lesions and the poor outcome of the patients.Results The lesions of the dorsal upper brain stein,the thalamus and the corpus callosum between the conscious and unconscious groups were significantly different.The lesions of the dorsal upper brain stem,the corpus callosum and the thalamic by MRI predict the poor outcomes.Conclusion The MRI manifestations can demonstrate the cerebral dysfunction and probabilities of patients' outcome objectively and accurately.