创伤性中脑周围池出血早期MRI检查对诊断及预后判断的价值

摘要

Objective To explore the value of MRI to diagnosis and prognosis of primary brain stem injury in patients with the CT demonstration of intracisternal hemorrhage around the midbrain. Methods The clinical and CT imaging data of 66 head injury patients with intracisternal hemorrhage around the midbrain were analyzed retrospectively . There were 63 patients using MRI within 72 hours post injury. Data of MRI and life quality through GOS were analyzed. Results The clinical manifestations and prognosis in all cases were compared with the MRI. The manifestations of brainstem injure were showed on MRI images in 47 (76.4% )cases, most of them with diffuse swelling,the more seirous swelling, the more severe prognosis of the patients,gently subarachnoid hemorrhage or no obvious brainstem change was noted in 13 (19.0% ). Conclusion The early CT manifestations of intracisternal hemorrhage around the midbrain strongly suggest the possibility of primary brainstem injury. And early MRI can provide a definite basis of diagnosis, treatment and prognosis.%目的 探讨外伤后急诊CT仅表现为中脑周围池出血的病例早期(＜72 h)MRI影像学表现与原发性脑干损伤之间的相关性,用以指导治疗及评价预后.方法 回顾性分析66例外伤后急诊CT显示中脑周围池出血的病例,63例于早期行MRI检查,对相关病例6个月后进行随访,根据GOS评价预后情况,从而得出早期MRI表现与诊断及预后之间的关系.结果 将所有病例的临床表现及预后情况与CT及MRI结果进行对照,47例(74.6％) MRI存在不同程度的脑干组织损伤,其中GCS评分越低、弥漫性脑肿胀、中脑周围池变窄等情况越严重,预后越差;13例(19.0％) MRI表现轻度蛛网膜下腔出血,未发现明显脑干部位异常,预后相对较好.结论 本组结果提示早期CT显示外伤性中脑周围池出血与原发性脑干损伤有高度相关性,而早期的MRI检查可以为诊断、治疗及预后提供较为可靠的依据,从而提高临床诊疗水平.