Abe Hiroaki, Shimoji Keigo, Nagamine Yoshihide, Fujiwara Satoru, Izumi Shin-Ichi
Department of Rehabilitation Medicine, Kohnan Hospital, Tohoku Ryogo Center, Sendai, Japan; Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Neural Plast. 2017;2017:9358092. doi: 10.1155/2017/9358092. Epub 2017 Feb 23.
We investigated the clinical predictors of the degree of recovery in patients with prolonged disorders of consciousness (PDC) caused by traumatic brain injury. Fourteen patients with PDC underwent two diffusion tensor imaging (DTI) studies; the first and second scans were performed at 345.6 ± 192.6 and 689.1 ± 272.2 days after the injury, respectively. In addition to the temporal changes in each of these diffusion parameters, fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), and radial diffusivity were assessed over a 1-year period. Relationship of clinical and DTI parameters with recovery from PDC (RPDC) was evaluated using Spearman's rank-correlation and stepwise multiple linear regression analysis. The mean FA and number of voxels with FA values > 0.4 (VsFA0.4) were significantly decreased at the second scan. A significant positive correlation was observed between the degree of RPDC and mean FA ( = 0.60) and VsFA0.4 ( = 0.68) as well as between the difference in VsFA0.4 ( = 0.63) and AD ( = 0.54) between the first and second scans. On multiple linear regression analysis, initial severity of PDC and the difference in AD remained significantly associated with the degree of RPDC. The microstructural white matter changes observed in this study indicate their potential relation with the degree of RPDC over the longer term.
我们研究了创伤性脑损伤所致长期意识障碍（PDC）患者恢复程度的临床预测因素。14例PDC患者接受了两次弥散张量成像（DTI）研究；首次和第二次扫描分别在受伤后345.6±192.6天和689.1±272.2天进行。除了这些弥散参数各自随时间的变化外，还在1年的时间内评估了分数各向异性（FA）、平均扩散率、轴向扩散率（AD）和径向扩散率。使用Spearman等级相关和逐步多元线性回归分析评估临床和DTI参数与PDC恢复（RPDC）之间的关系。第二次扫描时，平均FA以及FA值>0.4的体素数量（VsFA0.4）显著降低。观察到RPDC程度与平均FA（=0.60）和VsFA0.4（=0.68）之间以及首次和第二次扫描之间VsFA0.4的差异（=0.63）和AD（=0.54）之间存在显著正相关。在多元线性回归分析中，PDC的初始严重程度和AD的差异仍与RPDC程度显著相关。本研究中观察到的微观结构白质变化表明它们在长期内与RPDC程度可能存在关联。
