1Department of Neurological Surgery and.
2The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus; and.
Neurosurg Focus. 2019 Dec 1;47(6):E17. doi: 10.3171/2019.9.FOCUS19652.
Traumatic brain injury (TBI) is a common condition with many potential acute and chronic neurological consequences. Standard initial radiographic evaluation includes noncontrast head CT scanning to rapidly evaluate for pathology that might require intervention. The availability of fast, relatively inexpensive CT imaging has fundamentally changed the clinician's ability to noninvasively visualize neuroanatomy. However, in the context of TBI, limitations of head CT without contrast include poor prognostic ability, inability to analyze cerebral perfusion status, and poor visualization of underlying posttraumatic changes to brain parenchyma. Here, the authors review emerging advanced imaging for evaluation of both acute and chronic TBI and include QuickBrain MRI as an initial imaging modality. Dynamic susceptibility-weighted contrast-enhanced perfusion MRI, MR arterial spin labeling, and perfusion CT are reviewed as methods for examining cerebral blood flow following TBI. The authors evaluate MR-based diffusion tensor imaging and functional MRI for prognostication of recovery post-TBI. Finally, MR elastography, MR spectroscopy, and convolutional neural networks are examined as future tools in TBI management. Many imaging technologies are being developed and studied in TBI, and some of these may hold promise in improving the understanding and management of TBI. ABBREVIATIONS ASL = arterial spin labeling; CNN = convolutional neural network; CTP = perfusion CT; DAI = diffuse axonal injury; DMN = default mode network; DOC = disorders of consciousness; DTI = diffusion tensor imaging; FA = fractional anisotropy; fMRI = functional MRI; GCS = Glasgow Coma Scale; MD = mean diffusivity; MRE = MR elastography; MRS = MR spectroscopy; mTBI = mild TBI; NAA = N-acetylaspartate; SWI = susceptibility-weighted imaging; TBI = traumatic brain injury; UHF = ultra-high field.
创伤性脑损伤（TBI）是一种常见病症，可能会带来许多急性和慢性神经方面的后果。标准的初始放射学评估包括非对比头部 CT 扫描，以快速评估可能需要干预的病变。快速、相对廉价的 CT 成像的出现，从根本上改变了临床医生无创性观察神经解剖结构的能力。然而，在 TBI 的背景下，头部 CT 不增强的局限性包括预后能力差、无法分析脑灌注状态以及对脑实质创伤后潜在变化的可视化效果不佳。在这里，作者综述了新兴的高级影像学技术在急性和慢性 TBI 评估中的应用，并将 QuickBrain MRI 作为初始成像方式。动态磁敏感对比增强灌注 MRI、MR 动脉自旋标记和灌注 CT 被用于评估 TBI 后的脑血流。作者评估了基于磁共振的弥散张量成像和功能磁共振成像在 TBI 后恢复的预测。最后，MR 弹性成像、MR 波谱和卷积神经网络被视为 TBI 管理的未来工具。许多成像技术正在开发和研究中，其中一些可能有希望改善对 TBI 的理解和管理。缩写词 ASL = 动脉自旋标记；CNN = 卷积神经网络；CTP = 灌注 CT；DAI = 弥漫性轴索损伤；DMN = 默认模式网络；DOC = 意识障碍；DTI = 弥散张量成像；FA = 分数各向异性；fMRI = 功能磁共振成像；GCS = 格拉斯哥昏迷量表；MD = 平均弥散系数；MRE = MR 弹性成像；MRS = MR 波谱；mTBI = 轻度 TBI；NAA = N-乙酰天门冬氨酸；SWI = 磁敏感加权成像；TBI = 创伤性脑损伤；UHF = 超高场。
