Lagares Alfonso, Ramos Ana, Pérez-Nuñez Angel, Ballenilla Federico, Alday Rafael, Gómez Pedro A, Kaen Ariel, Lobato Ramiro D
Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain.
Acta Neurochir (Wien). 2009 Apr;151(4):341-56. doi: 10.1007/s00701-009-0194-8. Epub 2009 Feb 18.
The objective of this work is two-fold: to determine the role of MRI findings in establishing the prognosis of patients with moderate and severe traumatic brain injury (TBI) admitted to our centre, measured with different outcome scales; and to determine in which patients the information given by MR findings adds prognostic information to that from traditional prognostic factors.
One hundred patients suffering moderate or severe head injury in whom MRI had been performed in the first 30 days after trauma were included. The MRI was evaluated by two neuroradiologists who were not aware of the initial CT results or the clinical situation of the patients. Outcome was determined 6 months after head injury by means of the extended version of the Glasgow Outcome Scale. The prognostic capacity of the different factors related to outcome was compared by the analysis of receiver operating characteristic (ROC) curves and the area under the curve (AUC) for each factor.
There exists a clear relation between the depth of the traumatic lesions shown on MRI, and their classification by the proposed scale, and the outcome of patients suffering traumatic brain injury determined by different scales 6 months after injury.
The anatomical substrate of TBI depicted by MRI could be a useful prognostic tool in patients suffering moderate and severe head injury. Patients with a score of 4 or less on the motor subscale of the GCS scale are those who could benefit most from the prognostic information provided by MRI.
本研究有两个目的：确定MRI检查结果在评估我院收治的中重度创伤性脑损伤（TBI）患者预后中的作用，采用不同的预后量表进行测量；确定MRI检查结果所提供的信息在哪些患者中能为传统预后因素增添预后信息。
纳入100例在创伤后30天内进行了MRI检查的中重度颅脑损伤患者。由两名不知患者初始CT结果及临床情况的神经放射科医生对MRI进行评估。伤后6个月通过格拉斯哥预后量表扩展版确定预后。通过分析受试者工作特征（ROC）曲线及各因素的曲线下面积（AUC），比较不同预后相关因素的预后能力。
MRI显示的创伤性病变深度、根据所提议量表进行的分类与伤后6个月不同量表所确定的创伤性脑损伤患者的预后之间存在明显关联。
MRI所描绘的TBI解剖学基础可能是中重度颅脑损伤患者有用的预后工具。格拉斯哥昏迷量表运动亚量表评分4分及以下的患者可能从MRI提供的预后信息中获益最大。
