Reider-Groswasser I, Costeff H, Sazbon L, Groswasser Z
Department of Radiology, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Israel.
Brain Inj. 1997 Dec;11(12):865-70. doi: 10.1080/026990597122936.
The use of linear measurements in the analysis of CT scans of TBI patients was found to contribute to the understanding of brain damage and were correlated with outcome in severe traumatic close brain injured patients. The purpose of the present study was to analyse the data obtained by the linear measurements on CT studies of TBI patients who remained in persistent vegetative state following blunt head trauma. All 27 patients included in the study were reported to be neurologically normal prior to injury. Thirteen patients, 11 remaining in persistent vegetative state (responsive but unaware) and two who died, constituted the worst outcome group. Fourteen patients who regained consciousness, underwent multidisciplinary evaluation when their recovery reached a plateau and were ranked according to severity of residual symptoms and outcome. The degree of correlation with the overall vocational outcome parameter with the various radiological indices was calculated as the Spearman rank correlation coefficient, with correction for tied scores. Fisher's z transformation was used to combine results with those of our previous analysis. Three radiological parameters showed a statistically significant correlation with clinical outcome. These were the right and left septum-caudate distance and the cerebroventricular index 2; these showed Spearman rank coefficients of 0.52, 0.45 and 0.48; with two-tailed p-values under 0.01, 0.02 and 0.01 respectively. The width of the third ventricle suggested correlation with the clinical scoring. The findings of the present study point to the importance of loss of deep gray matter of the caudate nuclei and widening of the adjacent part of the lateral ventricles in catastrophic brain injury. This finding may highlight the role of localized ischemic changes, in addition to diffuse axonal injury. Values of over 8 mm for the width of the third ventricle and over 11 mm for septum caudate distance are suggestive of catastrophic and poor prognosis for recovery.
研究发现，在分析创伤性脑损伤（TBI）患者的CT扫描时使用线性测量有助于理解脑损伤情况，并且与重度创伤性闭合性脑损伤患者的预后相关。本研究的目的是分析对钝性头部外伤后处于持续性植物状态的TBI患者进行CT研究时通过线性测量获得的数据。该研究纳入的所有27例患者在受伤前据报告神经功能正常。13例患者，其中11例仍处于持续性植物状态（有反应但无意识），2例死亡，构成预后最差组。14例恢复意识的患者在恢复平稳期接受了多学科评估，并根据残留症状的严重程度和预后进行了排名。将各种放射学指标与总体职业预后参数的相关程度计算为Spearman等级相关系数，并对并列分数进行校正。使用Fisher z变换将结果与我们之前的分析结果相结合。三个放射学参数与临床预后显示出统计学上的显著相关性。这些参数是左右侧隔 - 尾状核距离和脑室指数2；它们的Spearman等级系数分别为0.52、0.45和0.48；双侧p值分别低于0.01、0.02和0.01。第三脑室宽度提示与临床评分相关。本研究结果表明，在灾难性脑损伤中，尾状核深部灰质丢失和侧脑室相邻部分增宽具有重要意义。这一发现可能突出了局部缺血性改变除弥漫性轴索损伤之外的作用。第三脑室宽度超过8mm以及隔 - 尾状核距离超过11mm提示预后灾难性且恢复不佳。
