Institute for Medical Imaging Technology, Shanghai Jiao Tong University, Shanghai, 200030, China.
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200030, China.
Neurosci Bull. 2020 Sep;36(9):985-996. doi: 10.1007/s12264-020-00542-2. Epub 2020 Jul 1.
Hydrocephalus is often treated with a cerebrospinal fluid shunt (CFS) for excessive amounts of cerebrospinal fluid in the brain. However, it is very difficult to distinguish whether the ventricular enlargement is due to hydrocephalus or other causes, such as brain atrophy after brain damage and surgery. The non-trivial evaluation of the consciousness level, along with a continuous drainage test of the lumbar cistern is thus clinically important before the decision for CFS is made. We studied 32 secondary mild hydrocephalus patients with different consciousness levels, who received T1 and diffusion tensor imaging magnetic resonance scans before and after lumbar cerebrospinal fluid drainage. We applied a novel machine-learning method to find the most discriminative features from the multi-modal neuroimages. Then, we built a regression model to regress the JFK Coma Recovery Scale-Revised (CRS-R) scores to quantify the level of consciousness. The experimental results showed that our method not only approximated the CRS-R scores but also tracked the temporal changes in individual patients. The regression model has high potential for the evaluation of consciousness in clinical practice.
脑积水通常通过脑脊髓液分流术（CSF）治疗大脑中过多的脑脊髓液。然而，要区分脑室扩大是由于脑积水还是其他原因，如脑损伤和手术后的脑萎缩，非常困难。因此，在决定是否进行 CSF 分流术之前，对意识水平进行非平凡的评估，以及对腰椎池进行持续引流试验在临床上非常重要。我们研究了 32 名不同意识水平的继发性轻度脑积水患者，他们在腰椎脑脊液引流前后接受了 T1 和弥散张量成像磁共振扫描。我们应用了一种新的机器学习方法，从多模态神经影像中找到最具判别力的特征。然后，我们建立了一个回归模型，将 JFK 昏迷恢复量表修订版（CRS-R）评分回归到量化意识水平。实验结果表明，我们的方法不仅可以近似 CRS-R 评分，还可以跟踪个体患者的时间变化。该回归模型在临床实践中评估意识具有很高的潜力。
