Jersey Sean L, Jesinger Robert A, Palka Peter
60th Medical Group, Department of Radiology, David Grant USAF Medical Center, 101 Bodin Circle, Travis AFB, CA 94535, USA.
Aviat Space Environ Med. 2013 Jan;84(1):3-11. doi: 10.3357/asem.3405.2013.
This was a retrospective observational study of imaging used to evaluate and treat 13 U-2 pilots with neurological decompression sickness (DCS). Magnetic resonance imaging (MRI) and computed tomography (CT) provided data for screening, diagnosis, and determinations of fitness to fly after recovery. While small series and case reports described the role of imaging in diving DCS, none addressed radiology's role in aviation DCS.
We performed a literature review of altitude DCS radiology studies. We then reviewed radiology images at our institution on U-2 pilots with neurological DCS between January 2002 and August 2010. We retrospectively analyzed MRI data for white matter hyper-intensities (WMHs), defined as hyperintense lesions > or = 3 mm on T2 and FLAIR. All studies occurred after hyperbaric oxygen (HBO) treatment.
There were 17 pilots who reported 20 neurological DCS incidents. Of these 17 pilots, 13 underwent imaging. Two (15%) demonstrated acute subcortical lesions on MRI, seven (54%) had asymptomatic WMHs, and six (46%) were normal. The clinical significance of the lesions is unknown. Consistent with diving DCS, imaging played no role in acute diagnosis. However, imaging was vital for determining fitness for return to flying. Additionally, CT identified a potentially predisposing sinus condition in one pilot which may enable return to flying after treatment.
Modern imaging has unique findings for altitude DCS patients. The high incidence of WMHs in this series is a matter of ongoing research to determine potential clinical consequences. Emerging techniques such as functional MRI may play important roles in future aeromedical decisions.
这是一项回顾性观察研究，旨在对13名患有神经减压病（DCS）的U-2飞行员进行评估和治疗时所使用的影像学检查。磁共振成像（MRI）和计算机断层扫描（CT）为筛查、诊断以及恢复后飞行适宜性的判定提供了数据。虽然小型系列研究和病例报告描述了影像学在潜水减压病中的作用，但尚无研究涉及放射学在航空减压病中的作用。
我们对高空减压病的放射学研究进行了文献综述。然后回顾了我们机构在2002年1月至2010年8月期间对患有神经减压病的U-2飞行员的放射学图像。我们回顾性分析了MRI数据，以查找白质高信号（WMH），其定义为在T2和液体衰减反转恢复序列（FLAIR）上大于或等于3毫米的高信号病变。所有研究均在高压氧（HBO）治疗后进行。
有17名飞行员报告了20起神经减压病事件。在这17名飞行员中，13人接受了影像学检查。其中两人（15%）在MRI上显示急性皮质下病变，七人（54%）有无症状的白质高信号，六人（46%）正常。这些病变的临床意义尚不清楚。与潜水减压病一致，影像学在急性诊断中没有作用。然而，影像学对于确定恢复飞行的适宜性至关重要。此外，CT在一名飞行员中发现了一种可能的易患鼻窦状况，这可能使该飞行员在治疗后能够恢复飞行。
现代影像学对于高空减压病患者有独特的发现。本系列中白质高信号的高发生率是一个正在进行研究以确定潜在临床后果的问题。诸如功能MRI等新兴技术可能在未来的航空医学决策中发挥重要作用。
