质子MR波谱对弥漫性轴索损伤的诊断价值  

The imaging study on the value of 1H-MR spectroscopy in diffuse axonal injury

作　　者：夏海坚[1] 孙晓川[1] 唐文渊[1] 郑履平[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,400016

出　　处：《中华放射学杂志》2007年第4期358-362,共5页Chinese Journal of Radiology

摘　　要：目的 探讨质子MR波谱（^1H-MRS）技术在弥漫性轴索损伤（DAI）临床诊断及预后评估中的价值。方法 搜集63例符合纳入标准的颅脑外伤病例进行MRI及1H-MRS检查，根据MRI的征象将全部病例分为DAI组和非DM组，再利用单纯随机抽样法随机选择20名健康成年人作为正常对照。利用1H-MRS比较DAI组和非DAI组胼胝体膝部、压部和基底节N-乙酰天冬氨酸（NAA）／肌酸和磷酸肌酸（Cr）、胆碱复合物（Cho）／Cr、肌醇（mINs）／Cr以及谷氨酸和谷氨酰胺（Glx）／Cr等指标的差异，分析不同观察点。H-MRS指标和伤后原发昏迷时间的关系。结果 正常对照组胼胝体膝部、压部和基底节NAA／Cr和Cho／Cr分别为1．19±0．18、1．21±0．24，1．89±0．17、1．84±0．14，1．57±0．16、1．85±0．25；DAI组分别为0．83±0．24、2．92±0．78，1．25±0．35、2．54±0．42，1．33±0．17、2．38±0．44；非DAI组分别为1．11±0．23、1．61±0．33，1．61±0．22、1．93±0．26，1．49±0．23、1．89±0．29，3组间上述部位NAA／Cr和Cho／Cr差异均有统计学意义（P值均〈0．05）。正常对照组胼胝体膝部、压部mlNs／Cr和GLx／Cr分别为0．20±0．03、0．24±0．04，0．27±0．04、0．31±0．04；DAI组分别为0．59±0．37、0．58±0．23，0．46±0．15、0．55±0．14；非DAI组分别为0．23±0．07、0．28±0．06，0．28±0．06、0．33±0．05，3组间上述部位mINs／Cr和Glx／Cr差异均有统计学意义（P值均〈0．05）。DAI组胼胝体膝部的Cho／Cr和伤后原发昏迷时间呈正相关（r=0．824，P〈0．01）。结论1H—MRS所提供的信息对于DAI的诊断、严重程度和预后的评估，以及治疗的调整具有重要意义；1H-MRS是MRI成像技术的有益补充。Objective To investigate the value of 1H_MRS in the diagnosis and prognosis of diffuse axonal injury （DAI）. Methods A prospective imaging study was performed in 63 patients with craniocerebral injury admitted from October 2002 to April 2004. Sixty-three patients were divided into DAI group （27 cases） and Non-DAI group （36 cases） according to the result of the MRI. Then, the ratio of NAA/Cr,Cho/Cr, mINs/Cr, and Glx/Cr at basal ganglia and genu and splenium of corpus callosum was quantified using 1H-MRS and compared between DAI group and Non-DAI group. Twenty healthy persons were served as control group. The relation between 1H-MRS indexes and period of primary post-injury was analyze＆ Results The results of NAA/Cr and Cho/Cr at genu and splenium of corpus callosum and basal ganglia of control group were 1.19 ±0. 18, 1.21 ±0.24; 1.89 ±0. 17, 1.84 ±0. 14; 1.57 ±0. 16, 1.85 ± 0. 25, which of DAI group were 0. 83 ± 0. 24, 2. 92 ± 0. 78 ; 1.25 ± 0. 35, 2. 54 ± 0. 42 ; 1.33 ± 0. 17, 2. 38 ± 0. 44, and those of Non-DAI group were 1.11 ± 0. 23, 1.61 ± 0. 33 ; 1.61 ± 0. 22, 1.93 ± 0. 26 ; 1.49 ± 0. 23, 1.89 ± 0. 29. The differences between them were statistically significant （ P 〈 0. 05 ）. The results of mINs/Cr and Glx/Cr at genu and splenium of corpus callosum of control group were0.20 ＋0.03, 0.24 ±0.04; 0.27 ±0.04, 0.31 ±0.04, which of DAI group were 0.59 ±0.37, 0. 58 ± 0. 23 ; 0. 46 ± 0. 15, 0. 55 ± 0. 14, and those of Non-DAI group were 0. 23 ± 0. 07, 0. 28 ± 0. 06; 0. 28 ＋ 0. 06, 0. 33 ± 0. 05. The differences between them at those 2 checkpoints were also statistically significant （ P 〈 0. 05 ）. A positive correlation between Cho/Cr at genu of corpus callosum and the period of primary unconciousness was identified in DAI group （ r = 0. 824, P 〈 0. 01 ）. Conclusions 1 H-MRS is a noninvasive modality in vivo for assessing the metabolic status of the brain after TBI and can detect the changes of cellular and molecular pathophysiology. 1H-MRS is beneficial t

关 键 词：脑弥漫性轴索损伤 磁共振波谱学 对比研究 诊断 质子MR波谱 

分 类 号：R445.2[医药卫生—影像医学与核医学] R651.2[医药卫生—诊断学]