Shanmuganathan Kathirkamanathan, Gullapalli Rao P, Mirvis Stuart E, Roys Steven, Murthy Prasad
Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, USA.
AJNR Am J Neuroradiol. 2004 Apr;25(4):539-44.
Patients with traumatic brain injury (TBI) and low Glasgow coma scale (GCS) scores may have severe injury associated with cellular disruption that can be studied with whole-brain apparent diffusion coefficient (ADC) histograms. We retrospectively studied this hypothesis and correlated ADC with GCS.
Twenty-one patients (37.81 +/- 41.3 years) with TBI were enrolled: Group A had normal MR imaging findings but low GCS scores (n = 6). Group B had brain stem injury with low GCS scores (n = 6). Group C had cortical lesions with normal GCS scores (n = 5), and group D had cortical lesions with low GCS scores (n = 4). Eleven control subjects were enrolled (32.7 +/- 19.2 years). Whole-brain ADC maps and histograms were generated and normalized for each subject. Mean and peak ADCs were determined. A one-sided t test was performed for each parameter. Average GCS scores and corresponding peak and mean ADCs were correlated.
Peak histogram values significantly differed between controls and groups A, B, and D (P <.0019, P <.00129, and P <.0148, respectively). In groups A and D, values were significantly skewed compared with control values. Mean ADC was significantly different between the control ADC and group A (P <.013) but not group C. In each group, peak ADC and GCS score were strongly correlated (R(2) = 0.67).
Whole-brain peak ADCs and GCS scores are significantly correlated in patients with TBI. Although conventional MR images were normal, ADC independently indicated TBI and better represents the degree of neurologic dysfunction.
创伤性脑损伤（TBI）且格拉斯哥昏迷量表（GCS）评分低的患者可能存在与细胞破坏相关的严重损伤，这可以通过全脑表观扩散系数（ADC）直方图进行研究。我们回顾性地研究了这一假设，并将ADC与GCS进行了相关性分析。
纳入21例TBI患者（年龄37.81±41.3岁）：A组患者磁共振成像（MR）表现正常但GCS评分低（n = 6）。B组患者有脑干损伤且GCS评分低（n = 6）。C组患者有皮质病变但GCS评分正常（n = 5），D组患者有皮质病变且GCS评分低（n = 4）。纳入11名对照者（年龄32.7±19.2岁）。为每位受试者生成全脑ADC图和直方图并进行归一化处理。确定平均ADC和峰值ADC。对每个参数进行单侧t检验。将平均GCS评分与相应的峰值和平均ADC进行相关性分析。
对照组与A、B、D组的直方图峰值显著不同（分别为P <.0019、P <.00129和P <.0148）。在A组和D组中，与对照值相比，数值明显偏态。对照ADC与A组的平均ADC有显著差异（P <.013），但与C组无显著差异。在每组中，峰值ADC与GCS评分密切相关（R² = 0.67）。
TBI患者的全脑峰值ADC与GCS评分显著相关。尽管传统MR图像正常，但ADC可独立提示TBI，且能更好地反映神经功能障碍的程度。
