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目的探讨MRI对头颅CT检查阴性的轻度创伤性脑损伤(mTBI)患者预后判断的价值。方法对60例CT检查阴性、MRI检查阳性的mTBI患者进行预后评估,分析MRI上病灶位置与患者临床资料及预后的关系,伤后6个月采用格拉斯哥预后扩展量表(GOSE)对患者进行预后判断评估。结果 60例患者中,恢复良好(GOSE 7~8分)45例,中等残疾(GOSE 5~6分)15例。全部患者CT检查均为阴性,而MRI检查发现异常信号,T_1WI为高、低信号,T_2WI及液体衰减反转恢复序列(FLAIR)均为高信号。MRI病灶位置、抑郁、注意力不集中及创伤后意识丧失在不同预后患者间比较均有统计学差异(均P<0.05)。多因素分析发现MRI额下叶病灶(OR=1.33,95%CI=1.45~1.76,P<0.05)、注意力不集中(OR=1.47,95%CI=1.38~1.59,P<0.05)、存在意识丧失(OR=1.01,95%CI=0.56~1.58,P<0.05)与患者发生中等残疾呈正相关。结论 MRI联合临床资料分析对评估mTBI患者预后具有很好的预测价值,进而能为mTBI患者的早期治疗、预后判断提供更多信息。
Objective To investigate the value of MRI in predicting the prognosis of mild traumatic brain injury (mTBI) patients with negative CT scans. Methods The prognosis of 60 patients with mTBI with negative CT and MRI was evaluated. The relationship between the location of the lesions and the clinical data and prognosis of the patients was analyzed. The prognosis of the patients was assessed by using the Glasgow Outcome Scale (GOSE) at 6 months after injury Judgment assessment. Results Of the 60 patients, 45 were well recovered (GOSE 7-8) and 15 were moderately disabling (GOSE 5-6). All patients were negative CT examination, MRI examination found abnormal signals, T_1WI high and low signal, T_2WI and fluid attenuation inversion recovery sequence (FLAIR) are high signal. The location of MRI lesion, depression, inattention and post-traumatic loss of consciousness were statistically different between different prognosis patients (all P <0.05). Multivariate analysis showed that the lower frontal lobe lesions of MRI (OR = 1.33, 95% CI = 1.45-1.76, P <0.05), attention deficit (OR = 1.47, 95% CI = 1.38-1.59, P <0.05) Loss of consciousness (OR = 1.01, 95% CI = 0.56 ~ 1.58, P <0.05) was positively correlated with moderate disability in patients. Conclusion MRI combined with clinical data analysis has a good predictive value for the prognosis of patients with mTBI, and thus can provide more information for the early treatment and prognosis of mTBI patients.