Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries
Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries
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DOI：
10.3171/jns.2006.104.5.720
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发表时间：
2006-05-01
影响因子：
4.1
通讯作者：
Bullock, MR
中科院分区：
文献类型：
--
作者：
Marmarou, A;Signoretti, S;Bullock, MR
Object.创伤性脑损伤（TBI）后与脑肿胀相关的水肿被认为是血管源性的，但作者以前的实验室研究结果表明，细胞形式的水肿是TBI后脑肿胀的主要原因。在这项研究中，作者使用磁共振（MR）成像技术，以确定类型的水肿发生在TBI患者。应用磁共振弥散加权成像（DWI）技术对44例格拉斯哥昏迷评分< 8分的颅脑外伤患者和8例健康志愿者的表观弥散系数（ADC）进行了测定。较高的ADC值与血管源性水肿相关，较低的ADC值与主要细胞形式的水肿相关。计算局灶性和弥漫性损伤患者的ADC区域测量值。还通过使用MR成像测量每克组织的水百分比，以绝对值评估脑组织的含水量。使用稳定的Xe计算机断层扫描（CT）研究来测量脑血流量（CBF），以排除缺血是细胞水肿的原因。健康志愿者的平均ADC值为0.82 +/- 0.05 × 10（-3）mm（2）/s。无肿胀的弥漫性脑损伤患者的ADC值接近健康志愿者的平均值。相比之下，脑肿胀患者的脑含水量增加，ADC值较低（平均值为0.74 +/- 0.05 x 10（-3）mm（2）/s）。ADC值与CT分型相关。在所有ADC值低的患者中，CBF值均超出缺血范围。在TBI患者中观察到的脑肿胀似乎主要是细胞性的，如具有高水平含水量的脑组织中的低ADC值所示。
Object. The edema associated with brain swelling after traumatic brain injury (TBI) has been thought to be vasogenic in origin, but the results of previous laboratory Studies by the authors have shown that a cellular form of edema is mainly responsible for brain swelling after TBI. In this study the authors used magnetic resonance (MR) imaging techniques to identify the type of edema that occurs in patients with TBI.Methods. Diffusion-weighted MR imaging was used to evaluate the apparent diffusion coefficient (ADC) in 44 patients with TBI (Glasgow Coma Scale Score < 8) and in eight healthy volunteers. Higher ADC values have been associated with vasogenic edema, and lower ADC values with a predominantly cellular form of edema. Regional measurements of ADC in patients with focal and diffuse injury were computed. The water content of brain tissue was also assessed in absolute terms by using MR imaging to measure the percentage of water per gram of tissue. Cerebral blood flow (CBF) was measured using stable Xe-computerized tomography (CT) studies to rule out ischemia as a cause of cellular edema.The mean ADC value in the healthy volunteers was 0.82 +/- 0.05 X 10(-3) mm(2)/second. The ADC values in the patients with diffuse brain injury without swelling were close to the mean for the healthy volunteers. In contrast, the patients with brain swelling had increased brain water content and low ADC values (mean 0.74 +/- 0.05 x 10(-3) mm(2)/second). The ADC values correlated with CT classifications. In all patients with low ADC values, the CBF values were outside the range for ischemia.Conclusions. The brain swelling observed in patients with TBI appears to be predominantly cellular, as signaled by low ADC values in brain tissue with high levels of water content.