磁敏感加权血管成像联合CT检测评估创伤性脑损伤后远期预后恢复的价值研究

Value of magnetic SWAN combined with CT examination in assessing the recovery of long-term prognosis post TBI

目的:探讨磁敏感加权血管成像(SWAN)联合头部计算机断层扫描(CT)检测评估创伤性脑损伤(TBI)后远期预后恢复的价值。方法:选取医院收治的80例TBI患者,根据患者24 h内按照格拉斯哥昏迷量表(GCS)评分分为轻度组(38例)和中重度组(42例);于伤后12个月按照GOS评分分为预后良好组(60例)和预后不良组(20例)。所有患者于入院时进行头部CT及SWAN检查,比较各组患者CT及SWAN图像中病灶数目及出血灶面积,采用Pearson线性相关分析出血灶面积及数目与GCS和GOS评分的相关性。采用受试者工作特征(ROC)曲线分析SWAN联合CT检测评估创伤性脑损伤后远期预后情况的价值。结果:SWAN及CT检查中,中重度组患者出血灶面积及数目明显均高于轻度组,差异有统计学意义(t_(SWAN)=501.330,t=87.686;t_(CT)=325.931,t=11.917;P<0.05)。Pearson线性相关分析中SWAN及CT检查出血灶面积及数目与GCS评分均成明显负相关(r_(SWAN)=-0.652,r=-0.659;r_(CT)=-0.526,r=-0.658;P<0.05)。SWAN及CT检查中,预后不良组患者出血灶面积及数目均明显高于预后良好组,差异具有统计学意义(t_(SWAN)=33.415,t=22.347;t_(CT)=27.678,t=17.049;P<0.05)。Pearson线性相关分析中SWAN及CT检查出血灶面积及数目与GOS评分成明显负相关(r_(SWAN)-0.582,r=-0.538;r_(CT)=-0.715,r=-0.468;P<0.05)。SWAN预测和CT预测TBI患者远期预后情况的ROC曲线下面积(AUC)分别为0.795和0.652;SWAN联合CT预测TBI患者远期预后情况的AUC为0.808。结论:SWAN较CT检查对TBI患者出血灶面积及数量具有明显优势,SWAN联合CT检测评估TBI患者预后情况具有一定的临床价值。

Objective:To analyze the value of magnetic susceptibility weighted angiography (SWAN) combined with computed tomography(CT)examination in assessing the recovery of long-term prognosis post traumatic brain injury(TBI).Methods:80 TBI patients who admitted to hospital were selected.And all of them were divided into mild group(38 cases)and moderate-severe group(42 cases)according to Glasgow coma scale(GCS)scores of patients within 24h.And these patients were further divided into favorable prognosis group(60 cases)and unfavorable prognosis group(20 cases)according to Glasgow outcome scale(GOS)12 months after injury.All patients were examined by CT and SWAN at admission.The number of lesions and area of bleeding foci were compared in CT and SWAN images between different group.Pearson linear correlation was adopted to analyze the correlation between the area and number of bleeding foci and GCS and GOS scores,respectively.The receiver operating characteristics(ROC)curve was used to analyze the value of SWAN combined with CT examination in assessing the condition of long-term prognosis post TBI.Results:In SWAN and CT examination,the area and the number of bleeding foci in moderate-severe group were significantly higher than those in mild group(t_(SWAN)=501.330,t=87.686,t_(CT)=325.931,t=11.917,P<0.05).Pearson linear correlation analysis showed that both the area and the number of bleeding foci were significantly negatively correlated with GCS scores in _(SWAN) and CT examination(r_(SWAN)=-0.652,r=-0.659,r_(CT)=-0.526,r=-0.658,P<0.05),respectively.In addition,the area and the number of bleeding foci in poor prognosis group were significantly higher than those in favorable prognosis group(t_(SWAN)=33.415,t=22.347,t_(CT)=27.678,t=17.049,P<0.05).Pearson linear correlation analysis showed that the area and number of bleeding foci of SWAN and CT examination were significantly negatively correlated with GOS scores(r_(SWAN)=-0.582,r=-0.538,r_(CT)=-0.715,r=-0.468,P<0.05),respectively.The area under curve(AUC)of SWAN and CT were 0.795 and 0.652 in predicting long-term prognosis of TBI patients,respectively,and that of the combination of SWAN and CT was 0.808 in predicting long-term prognosis of TBI patients.Conclusion:SWAN has obvious advantages over CT examination in confirming the area and number of bleeding foci of TBI patients.It is a certain of clinical value that the combination of SWAN and CT examination in assessing the prognosis of TBI patients.