Fakhran S, Qu C, Alhilali L M
From the Department of Radiology (S.F.), East Valley Diagnostic Imaging/Banner Health and Hospital Systems, Mesa, Arizona.
Department of Radiology (C.Q.), Division of Neuroradiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
AJNR Am J Neuroradiol. 2016 Aug;37(8):1556-60. doi: 10.3174/ajnr.A4730. Epub 2016 Mar 24.
Neck musculature mass has been suggested as a biomechanical contributor to injury severity in mild traumatic brain injury. We sought to determine how the cross-sectional areas of the suboccipital muscles affect symptom severity, neurocognitive performance, and recovery time in patients with mild traumatic brain injury.
Sixty-four consecutive patients with mild traumatic brain injury underwent MR imaging and serial neurocognitive testing with the Immediate Post-Concussion Assessment and Cognitive Test. Cross-sectional areas of the rectus capitis posterior musculature were retrospectively obtained at C1, and cross-sectional areas of the remaining 7 suboccipital muscles were measured at C2. Cross-sectional area reproducibility was evaluated. Overall and individual muscle cross-sectional areas were correlated with symptom severity, neuropsychological testing, recovery time, and headache.
Sixty-four patients with mild traumatic brain injury had imaging through C1, and 43 had imaging through C2. Reproducibility of cross-sectional area measurements was substantial (correlation coefficients = 0.9517-0.9891). Lower cross-sectional area of the rectus capitis posterior minor was correlated with greater symptom severity (r = 0.596, P < .0001), longer recovery time (r = 0.387, P = .002), poor verbal memory performance (r = 0.285, P = .02), and headache (r = 0.39, P = .001). None of the other cross-sectional areas were associated with symptom severity, recovery time, neurocognitive testing, or headache.
In mild traumatic brain injury, the rectus capitis posterior minor is the only suboccipital muscle whose cross-sectional area is associated with symptom severity and worse outcome. Given the unique connection of this muscle to the dura, this finding may suggest that pathology of the myodural bridge contributes to symptomatology and prognosis in mild traumatic brain injury.
颈部肌肉质量被认为是轻度创伤性脑损伤中影响损伤严重程度的生物力学因素。我们试图确定枕下肌肉的横截面积如何影响轻度创伤性脑损伤患者的症状严重程度、神经认知功能及恢复时间。
64例连续的轻度创伤性脑损伤患者接受了磁共振成像检查，并采用脑震荡后即刻评估和认知测试进行系列神经认知测试。回顾性获取C1水平头后直肌的横截面积，并测量C2水平其余7块枕下肌肉的横截面积。评估横截面积测量的可重复性。整体及各肌肉的横截面积与症状严重程度、神经心理学测试、恢复时间及头痛情况进行相关性分析。
64例轻度创伤性脑损伤患者进行了C1水平的成像检查，43例进行了C2水平的成像检查。横截面积测量的可重复性良好（相关系数=0.9517-0.9891）。头后小直肌横截面积较小与症状严重程度较高相关（r=0.596，P<0.0001）、恢复时间较长相关（r=0.387，P=0.002）、言语记忆功能较差相关（r=0.285，P=0.02）以及头痛相关（r=0.39，P=0.001）。其他横截面积与症状严重程度、恢复时间、神经认知测试或头痛均无关联。
在轻度创伤性脑损伤中，头后小直肌是唯一横截面积与症状严重程度及较差预后相关的枕下肌肉。鉴于该肌肉与硬脑膜的独特连接，这一发现可能提示肌硬膜桥的病变在轻度创伤性脑损伤的症状及预后中起作用。
