[1]张晓峰,张明文,于志虎,等. 弥散张量成像联合磁共振波谱在颅脑损伤昏迷患者预后评定中的应用[J].中国医学物理学杂志,2019,36(4):447-452.[doi:DOI:10.3969/j.issn.1005-202X.2019.04.015]
　ZHANG Xiaofeng,ZHANG Mingwen,YU Zhihu,et al. Application of diffusion tensor imaging combined with magnetic resonance spectroscopy in prognostic assessment of comatose patients with traumatic brain injury[J].Chinese Journal of Medical Physics,2019,36(4):447-452.[doi:DOI:10.3969/j.issn.1005-202X.2019.04.015]
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 弥散张量成像联合磁共振波谱在颅脑损伤昏迷患者预后评定中的应用()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
36卷
期数:
2019年第4期
页码:
447-452
栏目:
医学影像物理
出版日期:
2019-04-25

文章信息/Info

Title:
 Application of diffusion tensor imaging combined with magnetic resonance spectroscopy in prognostic assessment of comatose patients with traumatic brain injury
文章编号:
1005-202X（2019）04-0447-06
作者:
 张晓峰; 张明文; 于志虎; 朱林; 周雁玲
 南方医科大学附属小榄医院神经外科， 广东 中山 528415
Author(s):
 ZHANG Xiaofeng;  ZHANG Mingwen;  YU Zhihu;  ZHU Lin;  ZHOU Yanling
 Department of Neurosurgery, Xiaolan Hospital Affiliated to Southern Medical University, Zhongshan 528415, China
关键词:
 ; 脑损伤; 昏迷; 弥散张量成像; 磁共振波谱; 弥散系数
Keywords:
 ; Keywords: traumatic brain injury;  coma;  diffusion tensor imaging;  magnetic resonance spectroscopy;  diffusion coefficient
分类号:
R651.1
DOI:
DOI:10.3969/j.issn.1005-202X.2019.04.015
文献标志码:
A
摘要:
 目的：通过分析不同时期的创伤性脑损伤（TBI）昏迷患者弥散张量成像（DTI）与磁共振波谱（MRS）的变化，评价各参数与恢复期昏迷恢复量表（修订版）以及改良格拉斯哥预后评分的相关性，并探讨DTI联合MRS在TBI预后评定中的价值。方法:10 例TBI患者和10例正常对照者均接受常规核磁共振成像、DTI及MRS检查。测量正常对照组及TBI昏迷患者急性期（2～3周）和慢性期（大于4周）的丘脑板内核、网状核和脑干网状上行激动系统相关脑区（桥脑、延髓）的弥散各向异性、平均弥散系数、轴向弥散系数和径向弥散系数，并结合MRS的变化，测定乙酰天门冬氨酸、胆碱、肌酐和乳酸。正常对照组和TBI患者之间进行独立样本t检验，慢性期与急性期进行配对t检验，并将各参数与恢复期昏迷恢复量表（修订版）以及改良格拉斯哥预后评分作相关性分析。结果：TBI患者的DTI和MRS参数与正常对照者间存在显著区别，慢性期DTI及MRS能更好地提示TBI患者的预后情况。网状上行激动系统内的参数恢复慢于丘脑内的参数恢复。轴向弥散系数和径向弥散系数能更好地预判TBI昏迷患者的预后情况。结论：通过对病人脑内DTI及MRS的分析能预判TBI昏迷患者的恢复情况，指导临床治疗。
Abstract:
 Abstract: Objective To analyze the changes of diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS) in comatose patients with traumatic brain injury (TBI) at different stages for evaluating the correlations between the related parameters and coma recovery scale-revised score or the modified Glasgow outcome score, and exploring the application value of the combination of DTI and MRS in TBI prognostic assessment. Methods Ten TBI patients and 10 normal controls were scanned with magnetic resonance imaging, DTI and MRS. The related DTI parameters (fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity) of the thalamus (intralaminar nucleus, reticular nucleus) and brain regions related to ascending reticular activating system (pons, medulla) in normal controls and comatose patients with TBI in the acute stage (from 2 to 3 weeks) and the chronic stage (more than 4 weeks) were measured. Moreover, the acetyl aspartate, choline, creatinine and lactic acid were determined with MRS. The differences between normal controls and TBI patients were analyzed with independent sample t-test and the differences between the chronic stage and the acute stage were analyzed with paired t-test. Moreover, a correlation analysis was performed on the related parameters and coma recovery scale-revised score or the modified Glasgow outcome score. Results The DTI and MRS parameters of TBI patients were significantly different from those of normal controls. DTI and MRS in the chronic stage achieved a better assessment of the prognosis of TBI patients. The parameters in the ascending reticular activating system recovered more slowly than those in the thalamus. The prognosis of TBI patients was better predicted by axial diffusivity and radial diffusivity. Conclusion The prognosis of comatose patients with TBI can be predicted by the analysis on intracerebral DTI and MRS, so as to guide the treatment.

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备注/Memo

备注/Memo:
 【收稿日期】2018-11-02
【基金项目】中山市科技计划项目（2016B1063）
【作者简介】张晓峰，硕士，副主任医师，主要从事神经外科疾病的临床诊治，E-mail: zhangxf_zs@163.com
更新日期/Last Update: 2019-04-23