미만성 뇌손상 환자의 MRI 소견과 임상경과

Abstract

In the last decade Computed Tomography(CT) has played a Critical role in the diagnostic evaluation of the patients with focal brain injury. But it is apparent from pathologic studies that CT underestimates the severity of the many forms of cerebral injury such as primary brain stem injury, non-hemorrhagic cortical contusion and diffuse axonal injury(DAI). Magnetic Resonance Imaging(MRI), however, has been shown to be highly sensitive in detecting diffuse brain injury(DB1). Among the consecutive 13 cases of DBI patients in this series for 10 months, twelve patients were verified as MR evidence of injury in prospective studies. The anatomical distribution of the injuries were 11 cases of corpus callosal lesion, 6 cases of lobar white matter lesion 1 case of primary brain stem lesion. The sensitivities of MR imaging in detecting the primary lesion were 76.9% (10/13) in TlWI and 92.3% (12/13) in T2WI. In DBI, patients with callosal injuries had higher incidence(8/12) than lobar white matter and primary brain stem lesion, the corpus callosal atrophy by midsaggital MR imaging and behavioral seguellae in survivors of severe head injury implicate the corpus callosal injury and degeneration. More accurate detection and delineation of traumatic lesions with MR should permit more accurate prediction of neurologic and cognitive recovery and assist in optimizing form of treatment.

DBI 환자에서 뇌량 손상의 빈도가(8/12) 뇌엽 백질부나 일차 뇌간 손상보다 높았다. 그리고 뇌량 위축은 mid-saggittal imaging에서 가장 잘 볼수 있었으며 심한 두부손상후 생존한 환자에서의 행동장애는 뇌량손상과 위축으로 설명 되어질 수 있을것이다. 결론적으로 심한 두부 손상후 MR imaging을 이용하여 보다 정확하게 손상부위를 찾아내게 됨으로서 신경학적인 회복의 예측과 치료에 도움을 줄 수 있을것으로 생각된다.