The association between microhaemorrhages and post - traumatic functional outcome in the chronic phase after mild traumatic brain injury
The association between microhaemorrhages and post - traumatic functional outcome in the chronic phase after mild traumatic brain injury
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DOI：
10.1007/s00234-017-1898-8
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发表时间：
2017-10-01
期刊：
影响因子：
2.8
通讯作者：
van der Naalt, J.
中科院分区：
文献类型：
--
作者：
de Haan, S.;de Groot, J. C.;van der Naalt, J.
在轻度创伤性脑损伤（mTBI）后的慢性期，磁共振成像（MRI）经常检测到微出血。然而，目前尚不清楚微出血是否与功能结局相关，以及哪种MRI序列最适合解决这种相关性。我们的目的是确定损伤后慢性创伤后阶段微出血与功能结局之间的关系，并采用最合适的MRI序列来解决这种关系。根据MRI异常的存在情况，对2008年至2015年因持续创伤后主诉而入院的127例mTBI患者进行分层（n = 63（MRI+组）和n = 64无异常（MRI-组））。为了检测微出血，使用磁共振成像（SWI）和T2* 梯度回波（T2*GRE）。使用二元逻辑回归分析功能结局（二分格拉斯哥结局量表扩展评分）与微出血数量和位置之间的关系。SWI检测到的微出血数量是T2*GRE的两倍：341 vs. 179。病变主要存在于额叶和颞叶。MRI+组中67%的患者出现不良结局，SWI显示颞叶皮质区微出血总数与不良结局显著相关（OR 0.43（0.21-0.90）p = 0.02），解释方差为44%。微出血的数量与创伤后主诉的数量无关，慢性创伤后阶段的不良结局与颞叶皮质区微出血的存在和数量相关。SWI优选用于检测这些微出血。
In the chronic phase after mild traumatic brain injury (mTBI), microhaemorrhages are frequently detected on magnetic resonance imaging (MRI). It is however unclear whether microhaemorrhages are associated with functional outcome and which MRI sequence is most appropriate to address this association. We aimed to determine the association between microhaemorrhages and functional outcome in the chronic posttraumatic phase after injury with the most suitable MRI sequence to address this association.One hundred twenty-seven patients classified with mTBI admitted to the outpatient clinic from 2008 to 2015 for persisting posttraumatic complaints were stratified according to the presence of MRI abnormalities (n = 63 (MRI+ group) and n = 64 without abnormalities (MRI- group)). For the detection of microhaemorrhages, susceptibility-weighted imaging (SWI) and T2* gradient recalled echo (T2*GRE) were used. The relation between the functional outcome (dichotomized Glasgow Outcome Scale Extended scores) and the number and localization of microhaemorrhages was analysed using binary logistic regression.SWI detected twice as many microhaemorrhages compared to T2*GRE: 341 vs. 179. Lesions were predominantly present in the frontal and temporal lobes. Unfavourable outcome was present in 67% of the MRI+ group with a significant association of total number of microhaemorrhages in the temporal cortical area on SWI (OR 0.43 (0.21-0.90) p = 0.02), with an explained variance of 44%. The number of microhaemorrhages was not correlated with the number of posttraumatic complaints.An unfavourable outcome in the chronic posttraumatic phase is associated with the presence and number of microhaemorrhages in the temporal cortical area. SWI is preferably used to detect these microhaemorrhages.