DTI及DTT技术在弥漫性轴索伤预后判断中的作用

Study on the role of DTI and DTT in the prognosis of diffuse axonal injury

目的探讨磁共振弥散张量成像(DTI)及弥散张量纤维束成像(DTT)技术在弥漫性轴索损伤(DAI)患者预后判断中的作用。方法选取解放军联勤保障部队第九八八医院神经外科自2016年1月至2018年1月收治的34例DAI患者,于外伤后1周内行3.0T常规头颅MRI检查,同期行DTI及DTT成像。根据纤维束数量及形态预测患者预后并分为3级:Ⅰ级意识恢复伴或不伴有残疾,Ⅱ级植物生存,Ⅲ级为临床死亡。同时于患者伤后即行脑干听觉诱发电位(BAEP)监测,并于1周内完成,并根据Cant标准预测预后并分为3级:Ⅰ级意识恢复伴或不伴有残疾,Ⅱ级植物生存,Ⅲ级为临床死亡。根据实际结果对比2种方法的符合率,分析其预测的优劣。结果根据DTI及DTT预测显示,Ⅰ级15例,Ⅱ级13例,Ⅲ级6例;根据BAEP监测结果预测,Ⅰ级8例,Ⅱ级18例,Ⅲ级8例;其中在Ⅲ级结局的预测中BAEP准确率明显高于DTI及DTT,而在Ⅰ及Ⅱ级结局预测中DTI及DTT的准确率明显高于BAEP。结论DTI及DTT和BAEP在对DAI的病情判断及结局预测中各有优势,临床上二者应结合应用。

Objective To investigate the accuracy of diffusion tensor imaging(DTI)and diffusion tensor imaging tracking(DTT)in prognostic of patients with diffuse axonal injury(DAI).Methods Thirty-four patients with DAI,admitted to Neurosurgery Department of 988 Hospital Chinese People Liberation Army from January 2016 to January 2018,underwent 3.0T conventional cranial MRI within one week after trauma.DTI and DTT imaging were performed at the same time.According to the number and morphology of fiber bundles,the prognosis of patients was predicted and divided into three levels:levelⅠ,consciousness recovery with or without disability;levelⅡ,plant survival;levelⅢ,clinical death.At the same time,brainstem auditory evoked potential(BAEP)was monitored immediately after injury and completed within 1 week.According to the Cant criteria,the prognosis was predicted and divided into three grades:levelⅠ,consciousness recovery with or without disability;levelⅡ,plant survival;levelⅢ,clinical death.According to the actual results,the coincidence rate of the two methods is compared,and the advantages and disadvantages of the prediction are analyzed.Results According to the prediction of DTI and DTT,there were 15 patients in levelⅠ,13 patients in levelⅡand 6 patients in levelⅢ.According to the monitoring results of BAEP,there were 8 patients in levelⅠ,18 patients in levelⅡand 8 patients in levelⅢ.The accuracy of BAEP was significantly higher than that of DTI and DTT in the prediction of gradeⅢoutcomes,while the accuracy of DTI and DTT was significantly higher than BAEP in the prediction of gradeⅠandⅡoutcomes.Conclusion DTI,DTT and BAEP have their own advantages in the diagnosis and outcome prediction of diffuse axonal injury.