Sherer Mark, Stouter Josephine, Hart Tessa, Nakase-Richardson Risa, Olivier Jake, Manning Edward, Yablon Stuart A
Methodist Rehabilitation Center, Jackson, Mississippi 39216, USA.
Brain Inj. 2006 Sep;20(10):997-1005. doi: 10.1080/02699050600677055.
To examine the relationship between CT abnormalities and early neuropsychological outcome following traumatic brain injury (TBI) using quantitative CT analyses, data reduction methods for neuropsychological results and specific hypotheses based on literature review.
Observational, prospective cohort study using acute (emergency) CT data and neuropsychological test data from 89 participants with TBI who were hospitalized for rehabilitation.
Principal components analysis with varimax rotation was used to reduce data from a standard battery of eight neuropsychological tests administered after clearance of post-traumatic amnesia (1 month post-TBI on average). Bivariate correlations were used to examine relationships of three factors (verbal memory, cognitive processing speed and verbal working memory) to quantitative volumetric analysis of CT scan abnormalities (size, number and location). Specific hypotheses as to CT predictors of poor performance on each factor were tested using multivariable linear regression that included injury severity and demographic variables.
Eighty-nine per cent of participants had some pathology on initial CT. Age, education and time to follow commands (TFC), an index of overall injury severity, were significantly associated with the neuropsychological factors. However, none of the specific hypotheses about CT scan variables and cognitive outcome were strongly supported by the data. There was a trend for any CT abnormality to predict slower speed of processing and for higher number of brain lesions to predict worse memory performance.
Despite the precision added by quantitative CT analysis, CT findings did not improve on demographic factors and TFC in predicting early cognitive outcome of TBI. Imaging methods that are more sensitive to white matter integrity may be needed to develop pathophysiologic predictors of TBI outcome.
运用定量CT分析、神经心理学结果的数据简化方法以及基于文献综述的特定假设，研究创伤性脑损伤（TBI）后CT异常与早期神经心理学结果之间的关系。
一项观察性前瞻性队列研究，使用来自89名因康复住院的TBI患者的急性（急诊）CT数据和神经心理学测试数据。
采用主成分分析和方差最大化旋转，对创伤后遗忘清除后（平均TBI后1个月）进行的八项标准神经心理学测试的数据进行简化。使用双变量相关性分析来检验三个因素（言语记忆、认知处理速度和言语工作记忆）与CT扫描异常的定量体积分析（大小、数量和位置）之间的关系。关于每个因素表现不佳的CT预测指标的特定假设，使用包含损伤严重程度和人口统计学变量的多变量线性回归进行检验。
89%的参与者在初次CT检查时有一些病变。年龄、教育程度和听从指令时间（TFC）（总体损伤严重程度的一个指标）与神经心理学因素显著相关。然而，关于CT扫描变量和认知结果的具体假设均未得到数据的有力支持。存在一种趋势，即任何CT异常都预示着处理速度较慢，脑损伤数量较多预示着记忆表现较差。
尽管定量CT分析提高了精确性，但在预测TBI的早期认知结果方面，CT检查结果在人口统计学因素和TFC方面并无改善。可能需要对白质完整性更敏感的成像方法来制定TBI结果的病理生理预测指标。
