DWI联合SWI在脑梗死与脑出血急性期的诊断价值  

The value of DWI combined with SWI in diagnosis of cerebral infraction and cerebral hemorrhage in acute stage

作　　者：贺丹[1] 张玉笛[1] 姚洁[1] 刘宗杰[1] 李艳华[1] 王金艳[1] 

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000

出　　处：《脑与神经疾病杂志》2010年第5期390-394,共5页Journal of Brain and Nervous Diseases

摘　　要：目的探讨磁共振弥散加权成像(DWI)和磁敏感加权成像(SWI)在诊断和鉴别诊断急性缺血性和出血性脑血管病中的价值。方法采用GE3.0T磁共振DWI和SWI序列,对69例急性脑梗死和26例急性脑出血患者的影像学资料进行对比观察。结果脑梗死急性期,DWI表现为均匀高信号;SWI表现为等信号,当继发出血性转化时,SWI可见小斑点片状低信号。脑出血急性期,DWI血肿中心区表现为极低信号,周围水肿区表现为稍高信号,部分发病6～12h的血肿,其边缘可见特异性环形线状低信号;SWI血肿中心区表现为均匀片状低信号,周围水肿区表现为高信号。定量分析显示各时间点(<6h、7～12h和13～24h)血肿区表观弥散系数(ADC)值分别为3.65±1.04、3.72±0.67和3.78±0.84(×10-4),梗死区ADC值分别为6.22±1.12、5.79±2.04和4.85±0.84(×10-4),血肿区ADC值均低于梗死区ADC值,两者比较差异有统计学意义(P<0.05)。各时间点(<6h、7～12h和13～24h)血肿区相位(PV)值分别为-0.713、-0.710和-0.715,梗死后出血性转化区PV值分别为-0.338、-0.346和-0.332,血肿区PV值均低于梗死区PV值,两者比较差异有统计学意义(P<0.05)。结论脑梗死急性期和脑出血急性期DWI和SWI表现不同,DWI与SWI联合应用,是快速诊断和鉴别诊断急性脑血管病的有效方法,且对监测脑梗死后出血性转化(HT)具有重要临床意义。Objective To approach the value of diffusion weighted imaging(DWI)and susceptibility weighted imaging(SWI)on diagnosis and differential diagnosis of acute cerebral ischemic and hemorrhagic diseases.Methods The imageology data of 69 patients with acute cerebral infarction and 26 patients with acute cerebral hemorrhage were contrasted and observed on DWI and SWI sequence of GE 3.0T MR system.Results On the acute stage of cerebral infarction,DWI showed homogeneous hyperintensity and SWI showed isointensity.The small patching hypointensity could be seen on SWI after hemorrhagic transformation(HT).On the acute stage of cerebral hemorrhage,DWI showed extreme hypointensity in the center of hematoma,and slight hyperintensity in the edema region of perihematoma.The specific annuliform line hypointensity can be seen on some of the hematoma edge in the beginning of 6~12 hours after hemorrhage.SWI showed homogeneous lamellar hypointensity in the center of hematoma and hyperintensity in the edema region of perihematoma.In different time(<6h、 7~12h and 13~24h),the guantitis analysis explored that ADC in the hematoma area were 3.65±1.04、 3.72±0.67 and 3.78±0.84(×10-4),ADC in the infraction area were 6.22±1.12、5.79±2.04 and 4.85±0.84(×10-4).ADC in the hematoma area were lower than that in the infraction area(p<0.05).The phase value(PV)in the hematoma were-0.713、-0.710 and-0.715.PV in the infraction area were-0.338、-0.346 and-0.332.PV in the hematoma area were also lower than that in the infraction area(p<0.05).Conclusion DWI and SWI was different between acute cerebral infarction and acute cerebral hemorrhage.The uniting application is an effective method in tacho-diagnosis and differential diagnosis.It has significant meaning in detecting hemorrhagic transformation after cerebral infarction.

关 键 词：弥散加权成像 磁敏感加权成像 脑梗死 脑出血 出血性转化 表观弥散系数 相位值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]