摘要：

目的 分析轻型颅脑创伤患者扩散张量成像（DTI）参数及其与神经心理学测验的相关性，探讨轻型颅脑创伤急性期损伤机制。方法 共16 例轻型颅脑创伤患者和15 例性别、年龄、受教育程度相匹配的正常对照者，均行头部MRI 检查，包括T₁WI、T₂WI、T₂-FLAIR 成像和DTI，采用基于体素的形态学分析计算部分各向异性（FA）值、平均扩散率（MD）值和表观扩散系数（ADC）值，同时行神经心理学测验，包括Beck 抑郁量表（BDI）、状态-特质焦虑量表［分为状态焦虑量表（SAI）和特质焦虑量表（TAI）］，Spearman 秩相关分析探讨各脑区FA 值、MD 值和ADC 值与神经心理学测验的相关性。结果 与正常对照者相比，轻型颅脑创伤患者右侧额叶补充运动区FA 值降低，右侧额叶中央前回、缘上回和顶叶FA 值升高；双侧额叶、顶叶和右侧扣带回MD 值升高；双侧额叶和右侧顶叶、岛叶ADC 值升高。轻型颅脑创伤患者SAI 评分高于正常对照者［20.50（13.25，29.75）分对11（8，12）分；Z = -3.493，P = 0.000］，而BDI 评分和TAI 评分组间差异无统计学意义（均P > 0.05）。Spearman 秩相关分析显示，上述异常脑区FA 值（r_s = 0.369，P = 0.478）、MD 值（r_s = 0.295，P = 0.421）和ADC 值（r_s = 0.401，P = 0.394）与SAI 评分均无关联性。结论 轻型颅脑创伤急性期患者存在多个脑区DTI参数和相关神经心理变化，DTI可以为轻型颅脑创伤研究提供影像学标记。

关键词: 颅脑损伤, 磁共振成像, 弥散, 神经心理学测验

Abstract:

Objective  To analyze the correlation between diffusion tensor imaging (DTI) and neuropsychological tests in patients with mild traumatic brain injury (mTBI), and to explore the damage mechanism of acute mTBI.  Methods  A total of 16 mTBI patients and 15 sex-, age- and education-matched healthy controls were scanned at 3.0T MRI, including T₁WI, T₂WI, T₂-FLAIR and DTI. Voxel-based morphometry (VBM) was used to calculate fractional anisotropy (FA), mean diffusivity (MD) and apparent diffusion coefficient (ADC). Neuropsychological tests including Beck Depression Inventory (BDI), State Anxiety Inventory (SAI) and Trait Anxiety Inventory (TAI) were performed. Spearman rank correlation analysis explored the correlation between FA, MD, ADC values and neuropsychological tests.  Results  Compared with control group, FA value was decreased in supplementary motor area (SMA) of right frontal lobe, and increased in precentral gyrus and supramarginal gyrus of right frontal lobe and right parietal lobe; MD value was increased in bilateral frontal lobes, parietal lobes and right cingulate gyrus; ADC value was increased in bilateral frontal lobes, right parietal lobe and insular lobe in mTBI group. SAI score in mTBI group was significantly higher than that in control group [20.50 (13.25, 29.75) score vs. 11 (8, 12) score; Z = -3.493, P = 0.000), while BDI and TAI scores had no significant difference between 2 groups (P > 0.05, for all). Spearman rank correlation analysis showed there was no correlation between FA (r_s = 0.369, P = 0.478), MD (r_s = 0.295, P = 0.421) and ADC (r_s = 0.401, P = 0.394) values of abnormal brain regions and SAI score.  Conclusions  DTI parameters and related neuropsychological changes of multiple brain regions exist in acute mTBI. This study suggest that DTI can serve as a potential biomarker of mTBI.

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