年龄相关性钆渗漏入急性创伤性脑损伤患者的眼部结构。
Age-associated gadolinium leakage into ocular structures in patients with acute traumatic brain injury.
机构信息
Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room B1D733, Bethesda, MD 20892, USA.
Stroke, Cognition, and Neuroepidemiology Section, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room 4D37A, Bethesda, MD 20892, USA; Department of Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
出版信息
J Neurol Sci. 2024 Aug 15;463:123149. doi: 10.1016/j.jns.2024.123149. Epub 2024 Jul 22.
BACKGROUND
Gadolinium Leakage into Ocular Structures (GLOS) is common following acute cerebrovascular events. The objective of this study was to investigate the occurrence of GLOS in an acute traumatic brain injury (TBI) cohort without acute cerebrovascular injury and to explore associated factors.
METHODS
Enrolled acute TBI patients had a baseline MRI ≤48 h of injury (TP1) and follow-up MRI ≤72 h after baseline (TP2). Vitreous chamber enhancement and signal intensity ratios (SIRs) were calculated using pre- and post-contrast Fluid Attenuated Inversion Recovery (FLAIR). White matter hyperintensities (WMHs) were assessed using the Fazekas scale.
RESULTS
Of the 128 TBI patients included, median age was 47 years, 70% male, and 66% presented with Glasgow Coma Scale of 15. No GLOS was detected at TP1 but was present in 23% of patients at TP2. GLOS+ patients were older (68 years [56-76] vs 39 years [27-53], p < 0.001), more likely to report falls as injury mechanism (62% vs 36%, p = 0.006), report history of hypertension (41% vs 19%, p = 0.025), and had a higher burden of WMHs (59% vs 14% with a total Fazekas ≥2, p < 0.001). Quantitative SIRs confirmed qualitative assessments: GLOS+ patients had higher SIRs at TP2 (0.43 vs 0.22, p < 0.001). Age (OR 3.28, 95%CI [1.88-5.71], p < 0.001) and prior TBI history (OR 4.99, 95%CI [1.46-17.06], p = 0.010) were independent predictors of GLOS. When age was removed, total Fazekas score (OR 2.53, 95%CI [1.60-4.00], p < 0.001) was an independent predictor of GLOS.
CONCLUSIONS
GLOS is primarily associated with age and may serve as another imaging marker of chronic vascular disease.
背景
急性脑血管事件后，眼内结构的钆渗漏（GLOS）很常见。本研究的目的是调查无急性脑血管损伤的急性创伤性脑损伤（TBI）患者中 GLOS 的发生情况，并探讨相关因素。
方法
入组的急性 TBI 患者在损伤后≤48 小时（TP1）进行基线 MRI 检查，在基线后≤72 小时（TP2）进行随访 MRI 检查。使用增强前后的液体衰减反转恢复（FLAIR）计算玻璃体腔增强和信号强度比（SIR）。使用 Fazekas 量表评估脑白质高信号（WMHs）。
结果
在纳入的 128 例 TBI 患者中，中位年龄为 47 岁，70%为男性，66%的格拉斯哥昏迷量表评分为 15 分。TP1 时未检测到 GLOS，但在 23%的患者中 TP2 时存在 GLOS。GLOS+患者年龄更大（68 岁[56-76] vs 39 岁[27-53]，p<0.001），更有可能报告跌倒作为损伤机制（62% vs 36%，p=0.006），报告高血压病史（41% vs 19%，p=0.025），WMHs 负担更高（59% vs 14%，总 Fazekas≥2，p<0.001）。定量 SIR 证实了定性评估：GLOS+患者在 TP2 时的 SIR 更高（0.43 与 0.22，p<0.001）。年龄（OR 3.28，95%CI [1.88-5.71]，p<0.001）和既往 TBI 史（OR 4.99，95%CI [1.46-17.06]，p=0.010）是 GLOS 的独立预测因素。当去除年龄因素后，总 Fazekas 评分（OR 2.53，95%CI [1.60-4.00]，p<0.001）是 GLOS 的独立预测因素。
结论
GLOS 主要与年龄相关，可能是慢性血管疾病的另一种影像学标志物。
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