MRI对CT检查阴性轻度脑损伤患者预后判断的价值

Prognosis value of MRI scan in mild traumatic brain injury with negative CT findings

目的探讨MRI对头颅CT检查阴性的轻度创伤性脑损伤（mTBI）患者预后判断的价值。方法对60例CT检查阴性、MRI检查阳性的mTBI患者进行预后评估，分析MRI上病灶位置与患者临床资料及预后的关系，伤后6个月采用格拉斯哥预后扩展量表（GOSE）对患者进行预后判断评估。结果60例患者中，恢复良好（GOSE7N8分）45例，中等残疾（GOSE5～6分）15例。全部患者CT检查均为阴性，而MRI检查发现异常信号。T1WI为高、低信号。T2WI及液体衰减反转恢复序列（FLAIR）均为高信号。MRI病灶位置、抑郁、注意力不集中及创伤后意识丧失在不同预后患者问比较均有统计学差异（均P〈005）。多因素分析发现MRI额下叶病灶（OR=133．95％CI=1．45～1．76，P〈0．05）、注意力不集中（OR=1．47，95％CI=1．38～1．59，P〈005）、存在意识丧失（OR=1．01，95％C1=0．56~158，P〈0.05）与患者发生中等残疾呈正相关。结论MRI联合临床资料分析对评估mTBI患者预后具有很好的预测价值，进而能为mTBI患者的早期治疗、预后判断提供更多信息，．

Objective To evaluate the application of MRI scan in prediction for disease outcome of mild traumatic brain injury（mTBI） patients with negative CT findings. Methods The outcome of 60 mTBI patients with negative CT and positive MRI findings were retrospectively reviewed. The disease outcomes were assessed with Glasgow Outcome Scale- Extended （GOSE） at 6 months after traumatic injury. The relationship between the outcomes and location of disease on MRI or clinical find- ing was analyzed. Results The disease outcomes included good recovery （GOSE 7~8） in 45 cases and moderate disability （GOSE 5-6） in 15 cases. In MRI scan the lesions had relatively high or low intensity on T1WI, high intensity on T2WI and FLAIR. The location of lesions on MRI, the depressing feeling or poor concentration or loss of consciousness were associated with outcome prediction （all P〈0.05）. Multivariate analysis shewed that lesions in left lower frontal Iobe（OR=1.33, 95%C1= 1.45-1.76, P〈0.05）, poor concentration （OR=1.47, 95%C1=1.38~1.59, P〈0.05）, loss of consciousness （OR=1.01, 95%CI=0.56-1.58, P〈0.05） were correlated with moderate disability. Conclusion MRI and clinical findings are of predictive value for outcomes of mTBI patients with negative CT results.