磁敏感加权成像在弥漫性轴索损伤诊断和分级中的临床应用  

The Application of Susceptibility Weighted Imaging in Diagnosis and Classification of Diffuse Axonal Injury

作　　者：周福庆[1] 龚洪翰[1] 陈琪[1] 张宝红[1] 

机构地区：[1]南昌大学第一附属医院影像科,江西330006

出　　处：《临床放射学杂志》2012年第3期326-331,共6页Journal of Clinical Radiology

摘　　要：目的探讨磁敏感加权成像(susceptibility-weighted imaging,SWI)在弥漫性轴索损伤(diffuse axonal injury,DAI)的临床诊断和分级中的应用价值。资料与方法 26例DAI患者均行3.0 T MR检查,扫描序列包括T1WI、T2WI、液体衰减反转恢复(FLAIR)、扩散加权成像(DWI)及SWI,比较不同序列对DAI脑内病灶的显示率并分析其信号特征,评价SWI在DAI检查、诊断和分级中的作用。结果各序列显示脑内各部位DAI病灶平均检出数依次为:T1WI(0.327±0.910)、T2WI(0.523±1.332)、FLAIR(1.179±2.832)、DWI(1.417±3.579)、SWI(5.340±10.483),其中SWI序列检出DAI病灶的数目最多,共检出DAI出血灶833个,与T1WI、T2WI、FLAIR和DWI的差异有统计学意义(F值分别为12.42、14.29、15.34、20.36,P<0.001)。在SWI表现为斑点状或小结节低信号改变,位于白质及皮髓交界区病灶排列呈甩鞭样或串珠状,具有特征性。在SWI上,38.46%(10/26例)患者为DAI分级Ⅰ级,26.92%(7/26例)患者为DAI分级Ⅱ级,34.62%(9/26例)患者为DAI分级Ⅲ级,DAI分级与格拉斯哥昏迷评分(GCS)之间具有相关性(r=-0.759,P=0.00026),DAI的SWI分级能较好地反映DAI的损伤程度。结论SWI对DAI出血性病灶的检出具有较高的敏感性,能较常规MRI其他序列检出更多、更小病灶,其呈甩鞭样或串珠状排列更能体现DAI的损伤特点,较常规MRI序列更好地对DAI进行分级诊断,为临床预后提供重要依据。Objective To discuss the value of susceptibility weighted imaging（SWI） in diagnosis and classification of diffuse axonal injury.Materials and Methods 26 patients with DAI received conventional SE T1WI,TSE T2WI,T2 FLAIR,DWI,and SWI sequenced,the detection rate and the characteristic signals of cerebral DAI lesions was analyzed and compared among the sequences.Results The average detected numbers of DAI lesions were（0.327±0.910） on T1WI,（0.523±1.332） on T2WI,（1.179±2.832） on FLAIR,（1.417±3.579） on DWI,and（5.340±10.483） on SWI,respectively.The detected number of DAI lesion on SWI was highest and were significantly higher than that on SE T1WI,TSE T2WI,T2 FLAIR and DWI respectively（F value was 12.42,14.29,15.34,20.36 respectively,and P0.001）.The DAI lesions were hypointensity and dot-like on the SWI images,which were located in the deep white matter or the corticomedullary junction of the frontal and temporal lobes,and multiple lesions were arranged bead or whip like which were characteristic features.10 patients（38.46%） were assessed as DAI grade Ⅰ,7 patients（26.92%） were assessed as DAI grade Ⅱ,and 9 patients（34.62%） were assessed as DAI grade Ⅲ.Positive correlation existed between DAI classification and GCS score（r=-0.759,P=0.00026）.Conclusion SWI is superior to conventional MR imaging sequence in diagnosing DAI of the brain.

关 键 词：弥漫性轴索损伤 磁敏感加权成像 创伤性脑损伤 微出血 

分 类 号：R651.1[医药卫生—外科学] R445.2[医药卫生—临床医学]