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        "titulo" => "Magnetic Resonance in moderate and severe head injury&#58; comparative study of CT and MR findings&#46; Characteristics related to the presence and location of diffuse axonal injury in MR"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La TC craneal ha sido el m&#233;todo m&#225;s extendido en la evaluaci&#243;n de enfermos que han sufrido trauma craneal&#46; Sin embargo&#44; es poco sensible en la identificaci&#243;n de lesi&#243;n axonal difusa y lesiones en fosa posterior&#46; La RM craneal es una prueba potencialmente m&#225;s sensible pero de dif&#237;cil realizaci&#243;n en estos enfermos&#44; hecho que ha impedido la generalizaci&#243;n de su uso&#46;</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparar la capacidad de identificaci&#243;n de lesiones intracraneales postraum&#225;ticas por parte de las dos pruebas diagn&#243;sticas en enfermos con TCE grave y moderado&#44; y determinar qu&#233; caracter&#237;sticas radiol&#243;gicas en la TC se asocian a la presencia de LAD en RM y su gravedad cl&#237;nica&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyen en el estudio 100 enfermos con TCE moderado y grave a los que se ha realizado RM craneal dentro de los primeros 30 d&#237;as tras el trauma craneal&#46; Se recogieron todas las variables cl&#237;nicas potencialmente relacionadas con el pron&#243;stico de los enfermos&#44; as&#237; como los datos del TC inicial seg&#250;n la clasificaci&#243;n de Marshall y cols&#46; La RM fue evaluada de manera ciega por dos neurorradi&#243;logos que ignoraban al resultado de la TC inicial y la situaci&#243;n cl&#237;nica inicial del paciente&#46; Se recogieron todas las lesiones que presentaban&#44; as&#237; como su clasificaci&#243;n seg&#250;n la clasificaci&#243;n de lesiones asociadas con LAD&#44; descrita por Adams&#46; Se compararon los hallazgos en TC y RM&#44; evaluando la sensibilidad de cada prueba con respecto a los diferentes hallazgos&#46; Se estudiaron los hallazgos relacionados con la presencia de LAD en RM&#44; mediante estudio univariable&#44; usando la prueba de &#967;<span class="elsevierStyleSup">2</span> y correlaciones simples&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La RM es m&#225;s sensible que la TC para las lesiones en sustancia blanca cerebral&#44; cuerpo calloso y tronco&#46; Adem&#225;s&#44; detecta mayor n&#250;mero de contusiones&#46; La presencia de lesi&#243;n axonal difusa depende del mecanismo de producci&#243;n del trauma&#44; siendo m&#225;s frecuente en traumas de mayor energ&#237;a&#44; sobre todo en los accidentes de tr&#225;fico&#44; bien sea con autom&#243;vil o moto&#47;bici&#46; En cuanto a las caracter&#237;sticas radiol&#243;gicas asociadas a LAD la m&#225;s claramente relacionada es la hemorragia intraventricular&#46; La presencia de da&#241;o cada vez m&#225;s profundo y mayor puntuaci&#243;n en la escala de Adams se asocia a menor puntuaci&#243;n en la GCS y GCS motora&#44; y por consiguiente peor nivel de conciencia y mayor gravedad del trauma inicial&#44; confirmando el modelo de Ommaya&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cranial CT has been the most extended evaluation means for patients suffering head trauma&#46; However&#44; it has low sensitivity in the identification of diffuse axonal injury and posterior fossa lesions&#46; Cranial MR is a potentially more sensitive test but difficult to perform in these patients&#44; a fact that has hampered its generalised use&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To compare the identification capability of traumatic intracranial lesions by both diagnostic tests in patients with moderate and severe head injury and to determine which radiological characteristics are associated with the presence of diffuse injury in MR and their clinical severity&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">100 patients suffering moderate or severe head injury to whom a MR had been performed in the first 30 days after trauma were included&#46; All clinical variables related to prognosis were registered&#44; as well as the data from the initial CT following Marshall et al&#46;&#44; classification&#46; The MR was blindly evaluated by two neuroradiologists that were not aware of the initial CT results or the clinical situation of the patient&#46; All lesions were registered as well as the classification following the classification of lesions related to DAI described by Adams et al&#46; CT and MR findings were compared evaluating the sensitivities of each test&#46; Factors related to the presence of diffuse injury in MR were studied by univariate analysis using &#967;<span class="elsevierStyleSup">2</span> test and simple correlations&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">MR is more sensitive than CT for lesions in cerebral white matter&#44; corpus callosum and brainstem&#46; It also detects a greater number of cerebral contussions&#46; The presence of diffuse axonal injury depends on the mechanism of the trauma&#44; being more frequent in higher energy trauma&#44; specially in traffic accidents&#46; Among the radiological characteristics associated to DAI the most clearly related is intraventricular haemorrhage&#46; The presence of a deeper injury and a higher score in the scales of Adams is associated with a lower score in the GCS and motor GCS&#44; and so with a worse level of consciousness and bigger severity of injury&#44; confirming Ommaya&#39;s model&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Lagares&#44; A&#46;&#59; Ramos&#44; A&#44;&#59; Alday&#44; R&#46;&#59; Ballenilla&#44; F&#46;&#59; P&#233;rez&#44; A&#44;&#59; Arrese&#44; I&#46;&#59; Fern&#225;ndez-Al&#233;n&#44; J&#46;A&#46;&#59; Pascual&#44; B&#46;&#59; Kaen&#44; A&#46;&#59; G&#243;mez&#44; P&#46;A&#46;&#59; Lobato&#44; R&#46;D&#46;&#58; Resonancia magn&#233;tica en trauma craneal moderado y grave&#58; estudio comparativo de hallazgos en TC y RM&#46; Caracter&#237;sticas relacionadas con la presencia y localizaci&#243;n de lesi&#243;n axonal difusa en RM&#46; Neurocirug&#237;a 2006&#59; 17&#58; 105&#8211;118&#46;</p>"
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Vol. 17. Núm. 2.
Páginas 105-118 (enero 2005)
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Vol. 17. Núm. 2.
Páginas 105-118 (enero 2005)
Resonancia magnética en trauma craneal moderado y grave: estudio comparativo de hallazgos en TC y RM. Características relacionadas con la presencia y localización de lesión axonal difusa en RM
Magnetic Resonance in moderate and severe head injury: comparative study of CT and MR findings. Characteristics related to the presence and location of diffuse axonal injury in MR
Visitas
1619
A. Lagares
, R. Alday, A. Pérez-Núñez, I. Arrese, J.F. Alén, B. Pascual, A. Kaen, P.A. Gómez, R.D. Lobato
Servicios de Neurocirugía. Hospital 12 de Octubre. Madrid
A. Ramos*, F. Ballenilla*
* Servicios de Neurorradiología. Hospital 12 de Octubre. Madrid
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Resumen
Introducción

La TC craneal ha sido el método más extendido en la evaluación de enfermos que han sufrido trauma craneal. Sin embargo, es poco sensible en la identificación de lesión axonal difusa y lesiones en fosa posterior. La RM craneal es una prueba potencialmente más sensible pero de difícil realización en estos enfermos, hecho que ha impedido la generalización de su uso.

Objetivos

Comparar la capacidad de identificación de lesiones intracraneales postraumáticas por parte de las dos pruebas diagnósticas en enfermos con TCE grave y moderado, y determinar qué características radiológicas en la TC se asocian a la presencia de LAD en RM y su gravedad clínica.

Material y métodos

Se incluyen en el estudio 100 enfermos con TCE moderado y grave a los que se ha realizado RM craneal dentro de los primeros 30 días tras el trauma craneal. Se recogieron todas las variables clínicas potencialmente relacionadas con el pronóstico de los enfermos, así como los datos del TC inicial según la clasificación de Marshall y cols. La RM fue evaluada de manera ciega por dos neurorradiólogos que ignoraban al resultado de la TC inicial y la situación clínica inicial del paciente. Se recogieron todas las lesiones que presentaban, así como su clasificación según la clasificación de lesiones asociadas con LAD, descrita por Adams. Se compararon los hallazgos en TC y RM, evaluando la sensibilidad de cada prueba con respecto a los diferentes hallazgos. Se estudiaron los hallazgos relacionados con la presencia de LAD en RM, mediante estudio univariable, usando la prueba de χ2 y correlaciones simples.

Resultados

La RM es más sensible que la TC para las lesiones en sustancia blanca cerebral, cuerpo calloso y tronco. Además, detecta mayor número de contusiones. La presencia de lesión axonal difusa depende del mecanismo de producción del trauma, siendo más frecuente en traumas de mayor energía, sobre todo en los accidentes de tráfico, bien sea con automóvil o moto/bici. En cuanto a las características radiológicas asociadas a LAD la más claramente relacionada es la hemorragia intraventricular. La presencia de daño cada vez más profundo y mayor puntuación en la escala de Adams se asocia a menor puntuación en la GCS y GCS motora, y por consiguiente peor nivel de conciencia y mayor gravedad del trauma inicial, confirmando el modelo de Ommaya.

Palabras clave:
Lesión traumática cerebral
Trauma craneal
RM
TC
Lesión axonal difusa
Métodos de imagen
Summary
Introduction

Cranial CT has been the most extended evaluation means for patients suffering head trauma. However, it has low sensitivity in the identification of diffuse axonal injury and posterior fossa lesions. Cranial MR is a potentially more sensitive test but difficult to perform in these patients, a fact that has hampered its generalised use.

Objective

To compare the identification capability of traumatic intracranial lesions by both diagnostic tests in patients with moderate and severe head injury and to determine which radiological characteristics are associated with the presence of diffuse injury in MR and their clinical severity.

Material and methods

100 patients suffering moderate or severe head injury to whom a MR had been performed in the first 30 days after trauma were included. All clinical variables related to prognosis were registered, as well as the data from the initial CT following Marshall et al., classification. The MR was blindly evaluated by two neuroradiologists that were not aware of the initial CT results or the clinical situation of the patient. All lesions were registered as well as the classification following the classification of lesions related to DAI described by Adams et al. CT and MR findings were compared evaluating the sensitivities of each test. Factors related to the presence of diffuse injury in MR were studied by univariate analysis using χ2 test and simple correlations.

Results

MR is more sensitive than CT for lesions in cerebral white matter, corpus callosum and brainstem. It also detects a greater number of cerebral contussions. The presence of diffuse axonal injury depends on the mechanism of the trauma, being more frequent in higher energy trauma, specially in traffic accidents. Among the radiological characteristics associated to DAI the most clearly related is intraventricular haemorrhage. The presence of a deeper injury and a higher score in the scales of Adams is associated with a lower score in the GCS and motor GCS, and so with a worse level of consciousness and bigger severity of injury, confirming Ommaya's model.

Key words:
Traumatic brain injury
Head trauma
MR
CT
Diffuse axonal injury
Imaging methods

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