与慢性创伤性脑损伤相关的弥漫性轴索损伤：来自3T T2*加权梯度回波成像的证据。
Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T.
作者信息
Scheid Rainer, Preul Cristoph, Gruber Oliver, Wiggins Christopher, von Cramon D Yves
机构信息
Day Clinic of Cognitive Neurology, University of Leipzig, Liebigstrasse 22a, 04103 Leipzig, Germany.
出版信息
AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1049-56.
BACKGROUND AND PURPOSE
Diffuse axonal injury is frequently accompanied by tissue tear hemorrhages. We examined whether high field strength T2*-weighted gradient-echo imaging performed during the chronic stage of traumatic brain injury may have advantages in the evaluation of diffuse axonal injury as compared with T1- and T2-weighted MR imaging.
METHODS
Prospective MR imaging of 66 patients (age range, 17-57 years) was performed using a 3-T system 3 to 292 months (median, 23.5 months) after traumatic brain injury. T1-, T2-, T2*-hypointense and T2-hyperintense foci of 1- to 15-mm diameter were registered in 10 brain regions by two readers separately. Foci that appeared hypointense both on the T1- and T2- and/or on the T2*-weighted images were defined as traumatic microbleeds.
RESULTS
For 46 (69.7%) of the patients, T2*-weighted gradient-echo imaging revealed traumatic microbleeds. Hyperintense foci were observed on the T2-weighted images of only 15 (22.7%) patients. T2*-weighted imaging showed significantly more traumatic microbleeds (P =.000) than did T1- and T2-weighted imaging. Interobserver agreement was strong (kappa = 0.79, tau = 0.749, P =.000). For 14 (21.2%) of the patients, T2*-weighted gradient-echo imaging revealed traumatic microbleeds in the corpus callosum, whereas for only two (3%), hyperintense callosal lesions were seen on the T2-weighted images. Although a significant correlation existed between the total amount and callosal appearance of traumatic microbleeds and Glasgow Coma Scale scores (P =.000), no correlation existed with extended Glasgow Outcome Scale scores.
CONCLUSION
T2*-weighted gradient-echo imaging at high field strength is a useful tool for the evaluation of diffuse axonal injury during the chronic stage of traumatic brain injury. Diffuse axonal injury-related brain lesions are mainly hemorrhagic. The relevance of diffuse axonal injury for long-term clinical outcome is uncertain.
背景与目的
弥漫性轴索损伤常伴有组织撕裂出血。我们研究了在创伤性脑损伤慢性期进行的高场强T2*加权梯度回波成像与T1加权和T2加权磁共振成像相比，在评估弥漫性轴索损伤方面是否具有优势。
方法
对66例患者（年龄范围17 - 57岁）在创伤性脑损伤后3至292个月（中位数23.5个月）使用3T系统进行前瞻性磁共振成像。两名阅片者分别在10个脑区记录直径为1至15毫米的T1、T2、T2低信号和T2高信号病灶。在T1加权、T2加权和/或T2加权图像上均表现为低信号的病灶定义为创伤性微出血。
结果
46例（69.�%）患者的T2加权梯度回波成像显示有创伤性微出血。仅15例（22.7%）患者的T2加权图像上观察到高信号病灶。T2加权成像显示的创伤性微出血明显多于T1加权和T2加权成像（P = 0.000）。观察者间一致性较强（kappa = 0.79，tau = 0.749，P = 0.000）。14例（21.2%）患者的T2*加权梯度回波成像显示胼胝体有创伤性微出血，而T2加权图像上仅2例（3%）可见胼胝体高信号病灶。虽然创伤性微出血的总量和胼胝体表现与格拉斯哥昏迷量表评分之间存在显著相关性（P = 0.000），但与扩展格拉斯哥预后量表评分无相关性。
结论
高场强T2*加权梯度回波成像对于创伤性脑损伤慢性期弥漫性轴索损伤的评估是一种有用的工具。弥漫性轴索损伤相关的脑损伤主要为出血性。弥漫性轴索损伤对长期临床结局的相关性尚不确定。
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