头颅CT和MRI对重度颅脑损伤后昏迷患者的预后评估

Prognostic Value of Cerebral CT and MRI in Comatose Patients after Severe Traumatic Brain Injury

目的探讨头颅CT和MRI对评估重度颅脑损伤后昏迷患者预后的作用。方法回顾性分析98例重度颅脑损伤后昏迷患者的资料和CT、MRI资料检查结果。结果患者年龄、性别、瞳孔异常改变以及哥拉斯格昏迷评分(GCS)等不影响重度颅脑损伤后持续性植物状态的发生(PVS)(P>0.05);不能通过颅脑损伤早期的CT表现预测患者是否发生PVS(P>0.05);MRI显示存在胼胝体、放射冠损伤以及脑干被盖部损伤的重度颅脑损伤患者发生PVS的危险升高(P<0.05)。结论颅脑损伤早期的CT表现对PVS预测缺乏价值,而MRI显示存在胼胝体、放射冠损伤以及脑干被盖部损伤的颅脑损伤患者发生PVS的危险明显升高。

Objective To evaluate the value of cerebral CT and MRI in prediction of the recovery of comatose patients after severe traumatic brain injury.Methods Cerebral CT and MRI were performed in 98 comatose patients after severe traumatic brain injury.CT and MRI were reviewed by three neuroradiologists for the number,sizes,and location of brain lesions.Three neurologists assessed the patients at admission and 1 month after injury.The correlation among the neuroimaging finding,clinical examination index and the prognosis of the patients was analyzed.Results Clinical characteristics,such as initial score on the Glasgow Coma Scale,age,and pupillary abnormalities failed to predict recovery.Cerebral CT did not predict future recovery from post-traumatic coma.The patients in persistent vegetative state（PVS） revealed a significantly higher frequency of corpus callosum,corona radiate,and dorsolateral brainstem injuries than did patients who recovered within 1 month.Conclusion Cerebral CT findings in the acute stage after head injury can not predict the outcome of the post-traumatic PVS.There is a significant association between MRI findings and PVS：patients in coma with lesions in the corpus callosum,corona radiata or dorsolateral brainstem.