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目的探讨磁共振技术液体衰减反转恢复序列(fluid attenuated inversion recovery,FLAIR)和氢质子MR波谱(1H-MR spectroscopy,1H MRS)在非典型弥漫性轴索损伤(diffuse axonal injury,DAI)临床诊断中的价值。方法选择2002年10月至2008年1月收治的符合本研究纳入标准的颅脑外伤患者58例,根据诊断标准将全部病例分为DAI组和非典型DAI组,进行FLAIR和1HMRS检查,再随机选择20名健康成年人作为对照组。观察FLAIR对DAI组及非典型DAI组病例的诊断能力;利用1HMRS比较DAI组和非典型DAI组胼胝体膝部、压部和基底节N-乙酰天门冬氨酸/肌酸和磷酸肌酸(NAA/Cr)、胆碱复合物/肌酸和磷酸肌酸(Cho/Cr)、肌醇/肌酸和磷酸肌酸(mINs/Cr)以及谷氨酸和谷氨酰胺/肌酸和磷酸肌酸(Glx/Cr)等指标的差异。结果较之常规MRI,FLAIR对轴索病灶的发现能力明显提高,非典型DAI组的病灶分布及形态和DAI组类似,两者不同在于非典型DAI组分布于间脑以下水平的病灶明显少于DAI组。DAI组、非典型DAI组和对照组的NAA/Cr与Cho/Cr在胼胝体膝部、压部和基底节部位差异均有统计学意义,mINs/Cr和Glx/Cr在胼胝体膝部和压部差异有统计学意义;和对照组及非典型DAI组相比,DAI组于胼胝体膝部、压部和基底节有NAA/Cr降低和Cho/Cr升高,于胼胝体膝部和压部有mINs/Cr和Glx/Cr升高;和对照组相比,非典型DAI组于胼胝体膝部和压部有NAA/Cr降低和Cho/Cr升高,于胼胝体膝部有mINs/Cr升高,但变化程度均比DAI组低。结论非典型DAI组不仅有和DAI组类似的病灶分布和形态,还在胼胝体部位有与DAI组类似的伤后生化代谢改变,区别在于损伤波及范围和严重程度的不同。表明DAI不仅是重型脑伤的一种,它也存在于轻、中型脑伤中,磁共振技术在非典型DAI诊断中有很大价值。
Objective To investigate the clinical application of magnetic attenuated fluid recovery (FLAIR) and 1H-MR spectroscopy (1H MRS) in the diagnosis of atypical diffuse axonal injury (DAI) In the value. Methods Fifty-eight patients with craniocerebral trauma who met the criteria of our study from October 2002 to January 2008 were divided into DAI group and atypical DAI group according to the diagnostic criteria. FLAIR and 1H MRS were performed and then randomized Twenty healthy adults were selected as control group. To observe the diagnostic ability of FLAIR in patients with DAI and atypical DAI. 1HMRS was used to compare the N-acetyl-aspartate / creatine and creatine phosphorylation (NAA) in knee, pressure and basal ganglia in DAI group and atypical DAI group / Cr), Choline Complex / Cho / Cr, Inositol / Creatine and Creatine Phosphate (mINs / Cr), and Glutamate and Glutamine / Creatine and Creatine Phosphate (Glx / Cr) and other indicators of the difference. Results Compared with conventional MRI, the ability of FLAIR to detect axonal lesions was significantly improved. The distribution and morphology of lesions in atypical DAI group were similar to those in DAI group. The difference between the two groups was that the number of lesions distributed in the atypical DAI group was significantly less than that in the diencephalon DAI group. The differences of NAA / Cr and Cho / Cr in DAI group, atypical DAI group and control group were statistically significant in the knee, the pressure and the basal ganglia of the corpus callosum. The differences of mINs / Cr and Glx / Cr between the knee and the pressure of the corpus callosum The difference was statistically significant. Compared with the control group and the atypical DAI group, the DAI group had decreased NAA / Cr and Cho / Cr elevation in the knee, pressure and basal ganglia of the corpus callosum and mINs in the knee and the pressure of the corpus callosum / Cr and Glx / Cr were increased. Compared with the control group, the atypical DAI group had decreased NAA / Cr and increased Cho / Cr in the knee and pressure of the corpus callosum, but increased mINs / Cr in the knee of the corpus callosum The degree of change is lower than the DAI group. Conclusion The atypical DAI group not only has similar lesion distribution and morphology as the DAI group, but also has similar post-injury biochemical metabolism changes in the corpus callosum with DAI group, with the difference being in the scope and severity of injury. That DAI is not only a severe brain injury, it also exists in light and medium brain injury, magnetic resonance imaging technology in the diagnosis of atypical DAI has great value.