功能磁共振技术在脑外伤所致精神障碍者精神伤残评定中的价值  

Evaluation of Functional Magnetic Resonance Imaging in the Assessment of Psychiatric Impairment Induced by Traumatic Brain Injury

作　　者：汤涛[1] 张钦廷[1,2] 蔡伟雄[1] 刘超[1] 汤伟军[3] 

机构地区：[1]司法部司法鉴定科学技术研究所上海市法医学重点实验室,上海200063 [2]上海交通大学医学院附属精神卫生中心,上海200032 [3]复旦大学附属华山医院,上海200040

出　　处：《中国司法鉴定》2015年第5期29-33,共5页Chinese Journal of Forensic Sciences

基　　金：国家自然科学基金(81001354);上海市法医学重点实验室资助项目(14DZ2270800)

摘　　要：目的探索功能磁共振成像技术(SWI、DTI、BOLD-f MRI)在精神伤残评定中的运用价值。方法对被试对象进行精神伤残评定,收集被试受伤当时及近期头颅CT片;评残时对被试对象进行SWI和DTI检查,部分接受BOLD-f MRI检查。结果脑震荡患者评残时SWI、DTI均无脑器质性损害发现;SWI对脑器质性损害的检出率优于CT;DTI对检测脑白质纤维的完整性有效;BOLD数据的结果与行为学的结果和评残结果存在不一致。结论 SWI在某些特定的病例(如临床表现与CT表现不一致),可作为一种寻找脑器质性损害证据的补充方法;DTI在一些特定案例(脑白质纤维受损)可能会有一定帮助,可以有选择地开展;运用SWI、DTI检查尚难以发现脑震荡患者存在脑器质性损害证据;BOLD-f MRI并不能提供更多更可靠的证据,实用价值不大。Objective To explore the application of Functional Magnetic Resonance Imaging in the assessment of psychiatric impairment induced by traumatic brain injury. Method The patients＂ CT scan images of skull, including those scanned right after the incident of injury and recently, were collected, and then the forensic assessment of mental disorder for these patients was conducted. During the assessment, SWI and DTI were used. In addition, some of the patients were required to undertake BOLD-fMRI. Results There was no finding of organic brain damage in the patients with brain concussion, according to the results of SWI and DTI. In comparison to CT, SWI has a higher rate in detecting organic brain damage. DTI is effective in examining the completeness of brain white matter fiber. The BOLD results were inconsistent with those of behaviour study and impairment assessment. Conclusion For some cases, particularly when there is inconsistence between clinical manifestations and CT results, SWI can be considered as an additional method to search for organic brain damage evidence. DTI can be useful and selectively applied in cases of brain white matter fiber injury. It is still difficult to detect evidence for the existence of organic brain damage in the patients with brain concussion using SWI and DTI. Because BOLD-fMRI cannot provide additional or more reliable evidence, it is of little value in forensic practice.

关 键 词：法医精神病学 脑外伤 精神伤残 功能磁共振成像 

分 类 号：DF795.3[医药卫生—法医学]