脑弥漫性轴索损伤的MRI征象及与GCS计分及预后的关系

目的：探讨脑弥漫性轴索损伤（DAI）的磁共振成像（MRI）征象及其与格拉斯哥昏迷量表评分（GCS）计分和预后的关系。方 法：回顾性分析2012 年1 月-2014 年7 月我院收集的30 例DAI 患者的临床病历资料，根据病灶累及部位分析其与GCS 计分和 临床预后的关系。结果：30 例患者共53 个病灶，17例多发病灶，13 例单发病灶；42 个病灶T1WI显示出低信号或者是等信号，11 个病灶T1WI显示为高信号；T2WI显示为高信号，FLAIR 序列以及弥散加权像（DWI）上表现出的信号更高，范围更清晰；病灶形 态呈条索状27 例，斑片状11 例，卵圆形8 例，不规则斑点状7 例；病灶未累及脑中线部位的患者临床预后优于病灶累及脑中线 部位的患者，差异有统计学意义（Z=-2.636，P=0.008），病灶累及脑中线部位的患者GCS 计分情况比未累及组严重，计分更低，差 异有统计学意义（Z=-2.519，P=0.012）。结论：DAI病灶累及脑中线部位的患者GCS计分较低、预后差，MRI检查是诊断DAI 首选 的影像学方法，临床有重要的参考价值。

Relationships between MRI Sign and GCS, Clinical Prognosis in Patients with Diffuse Axonal Injury

Objective:To investigate the MRI sign in patients with diffuse axonal injury (DAI) and its relationship with Glasgow Coma Scale(GCS) and clinical prognosis.Methods:A total of clinical data of 30 patients with DAI,who were admitted to the department of cerebral surgery in our hospital from January 2012 to July 2014, were retrospectively analyzed,and according to the lesion site of involvement, its relationships with GCS and clinical prognosis were evaluated.Results:There were a total of 53 lesions in the 30 patients with DAI,among which,there were 17 with multiple lesions and 13 with single lesion. T1WI of 42 lesions showed low or equal signals; while T1WI of 11 lesions showed high signals . High signal was indicated in T2WI and higher signal and higher imaging were showed on the FLAIR sequence and diffuse weighted imaging (DWI). The lesions showed different forms: 27 cases of cords, 11 cases of patchy, 8 cases of oval and 7 cases of irregular mottled lesions. The clinical prognosis of patients whose lesions did not involve the brain midline was superior to that of patients whose lesions involved the brain midline, with statistical significance(Z=-2.636,P=0.008). The GCS score in patients whose lesions involved the brain midline was lower than that in patients whose lesions didn''t involve the brain midline, with statistical significance(Z=-2.519, P=0.012).Conclusion:The patients with DAI whose lesions involved the brain midline have lower GCS score and poor prognosis. So for the patients with DAI, MRI examination is the preferred imaging diagnosis methodology, which can be used for the clinical reference.