Okamoto T, Hashimoto K, Aoki S, Ohashi M
Department of Rehabilitation Medicine, Kanagawa Rehabilitation Hospital, Atsugi, Japan.
Eur J Neurol. 2007 May;14(5):540-7. doi: 10.1111/j.1468-1331.2007.01742.x.
To evaluate the utility of easy Z-score imaging system (eZIS) in 27 diffuse axonal injury (DAI) cases. Twenty-seven DAI patients were examined with an magnetic resonance imaging (MRI) T2* sequence and with eZIS (seven women, 20 men; age range, 19-35 years; median age: 26.6 years). In this investigation, we excluded patients who exhibited complications such as acute subdural hematoma, acute epidural hematoma, intracerebral hematoma, or brain contusion. We examined the neuropsychological tests and correlated with findings from MRI/eZIS. Furthermore, we evaluated the degree of ventricular enlargement in the bifrontal cerebroventricular index (CVI). Patients were divided into two groups: the enlargement group (bifrontal CVI > 35%, 12 patients) and the non-enlargement group (bifrontal CVI < 35%, 15 patients). All of the patients showed cognitive deficits as observed from the neuropsychological test results. Fifteen out of 27 patients by MRI T1/T2 weighted images and fluid attenuated inversion recovery (FLAIR), 22 out of 27 patients by MRI T2* weighted images and 24 out of 27 patients by eZIS showed abnormal findings. In MRI T2* weighted imaging, the white matter from the frontal lobe, corpus callosum, and brainstem showed abnormal findings. With eZIS, 22 patients (81.5%) showed blood flow degradation in the frontal lobe, and 12 patients (44.4%) in cingulate gyrus. In the enlargement group, Functional Independence Measure, Mini-Mental State Examination, Verbal IQ (VIQ)/Full Scale IQ (FIQ), Trail Making Test-B (TMT-B), and Non-paired of Miyake Paired Test were significantly lower. Amongst 12 patients without ventricular enlargement who had no abnormal findings in MRI T1/T2 weighted images and FLAIR, abnormal findings were detectable in seven patients with MRI T2* weighted imaging and to 10 patients with eZIS. Results of the MRI examination alone cannot fully explain DAI frontal lobe dysfunction. However, addition of the eZIS-assisted analysis derived from the single photon emission computed tomography (SPECT) data enabled us to understand regions where blood flow was decreased, i.e., where neuronal functions conceivably might be reduced.
评估简易Z评分成像系统（eZIS）在27例弥漫性轴索损伤（DAI）病例中的应用价值。对27例DAI患者进行了磁共振成像（MRI）T2序列和eZIS检查（7例女性，20例男性；年龄范围19 - 35岁；中位年龄：26.6岁）。在本研究中，我们排除了出现急性硬膜下血肿、急性硬膜外血肿、脑内血肿或脑挫裂伤等并发症的患者。我们检查了神经心理学测试，并将其与MRI/eZIS的结果进行关联。此外，我们评估了双侧额叶脑室指数（CVI）中的脑室扩大程度。患者被分为两组：扩大组（双侧额叶CVI > 35%，12例患者）和非扩大组（双侧额叶CVI < 35%，15例患者）。所有患者从神经心理学测试结果来看均表现出认知缺陷。27例患者中，15例通过MRI T1/T2加权图像和液体衰减反转恢复序列（FLAIR）显示异常结果，27例患者中22例通过MRI T2加权图像显示异常结果，27例患者中24例通过eZIS显示异常结果。在MRI T2加权成像中，额叶、胼胝体和脑干的白质显示异常结果。使用eZIS时，22例患者（81.5%）额叶血流降低，12例患者（44.4%）扣带回血流降低。在扩大组中，功能独立性测量、简易精神状态检查、言语智商（VIQ）/全量表智商（FIQ）、连线测验B（TMT - B）和宫下非配对测验得分显著更低。在12例脑室未扩大且MRI T1/T2加权图像和FLAIR无异常结果的患者中，7例通过MRI T2加权成像显示异常结果，10例通过eZIS显示异常结果。仅MRI检查结果不能完全解释DAI额叶功能障碍。然而，添加源自单光子发射计算机断层扫描（SPECT）数据的eZIS辅助分析，使我们能够了解血流减少的区域，即推测神经元功能可能降低的区域。
