磁敏感加权成像对急性隐匿性小灶性出血性脑挫伤诊断价值  

Diagnostic value of susceptibility weighted imaging for acute occult small focal hemorrhagic brain contusion

作　　者：陈莉[1] 杨先春[1] 吴汉斌[1] 左敏[1] 杨克勤[1] CHEN Li;YANG Xian-chun;WU Han-bin;ZUO Min;YANG Ke-qin(Department of Radiology,Affiliated Hanyang Hospital of Wuhan Science and Technology University,Wuhan 430050,P.R.China)

机构地区：[1]武汉科技大学附属汉阳医院放射科

出　　处：《社区医学杂志》2019年第21期1335-1338,共4页Journal Of Community Medicine

基　　金：武汉市卫生健康委员会科研项目（WX17D25)

摘　　要：目的急性隐匿性小灶性出血性脑挫伤(acute occult mini-focal hemorrhagic cerebral contusion,AOMHCC)是脑外伤患者中一种相对少见的颅脑损伤疾病,目前该病早期临床漏诊率高,脑挫伤后遗症频发。本研究探讨磁敏感加权成像(susceptibility weighted imaging,SWI)对AOMHCC的价值,旨在提高该病早期诊断水平,减少漏诊率和脑挫伤后遗症发生率。方法选取2016-01-02-2018-05-30武汉科技大学附属汉阳医院96例脑外伤患者中,对经CT和磁共振成像(magnetic resonance imaging,MRI)联合诊断的49例AOMHCC患者临床和影像资料进行回顾性分析,评价随访CT、MRI常规序列、扩散加权成像(diffusion weighted imaging,DWI)以及SWI 4种检查方式对AOMHCC的敏感性、特异性、准确率、阴性预测值和阳性预测值。结果96例脑外伤患者CT初诊检查均未发现脑损伤,经CT随访复查和(或)MRI多序列联合诊断共发现49例AOMHCC患者67个病灶。49例AOMHCC患者中,随访CT复查检出11例,MRI常规序列检出26例,DWI检出40例,SWI检出48例。随访CT、MRI常规序列与临床诊断的一致性较差,Kappa值<0.4,没有临床使用价值;DWI序列的一致性较高,Kappa=0.688,但远低于SWI,Kappa=0.917,表明SWI序列对检测AOMHCC中的临床价值最大;且其灵敏度和特异度指标均>90%,与其他检查方式比较,各指标差异均有统计学意义,均P<0.001。结论磁共振SWI序列检查是诊断AOMHCC最有效的影像检查方式,早期应用磁共振SWI序列有助于AOMHCC早发现、早诊断和早治疗,可有效减少该病的漏诊率和脑挫伤后遗症发生率。OBJECTIVE Acute occult focal hemorrhagic cerebral contusion(AOMHCC)is a relatively rare brain injury disease in patients with brain trauma.At present,the early diagnosis of this disease has a high rate of clinical missed diagnosis,and the sequelae of brain contusion are frequent.This study explores the diagnostic value of susceptibility weighted imaging(SWI)in AOMHCC,in order to improve the early diagnosis level of the disease and reduce the rate of missed diagnosis and the incidence of sequelae of brain contusion.METHODS Totally 96patients with brain trauma in Hanyang Hospital Affiliated to Wuhan University of Science and Technology from January 2,2016to May 30,2018were selected.The clinical and imaging data of 49patients with acute occult focal hemorrhagic cerebral contusion diagnosed by CT and magnetic resonance imaging(MRI)were retrospectively analyzed.Follow-up CT,conventional sequence and expansion of MRI were evaluated.The sensitivity,specificity,accuracy,negative predictive value and positive predictive value of diffusion weighted imaging(DWI)and SWI for acute occult focal hemorrhagic cerebral contusion were studied.RESULTS No trace of brain injury was found in 96patients with traumatic brain injury.A total of 49patients with acute occult small focal hemorrhagic brain contusion were found by CT follow-up and/or MRI multiple sequence combined diagnosis.Of the 49patients with AOMHCC,11were followed up for CT,26cases were detected by MRI routine sequence,40cases were detected by DWI,and 48cases were detected by SWI.The follow-up CT and MRI routines were in poor agreement with clinical diagnosis.The Kappa value was<0.4,and there was no clinical use value.The consistency of DWI sequences was higher,Kappa=0.688,but much lower than SWI,Kappa=0.917.The results showed that the SWI sequence had the greatest clinical value in detecting AOMHCC;and its sensitivity and specificity index were all>90%.Compared with other examination methods,the differences of each index were statistically significant.P<0.001.CONCLUSIONS

关 键 词：急性隐匿性小灶性出血性脑挫伤 扩散加权成像 磁共振成像 磁敏感加权成像 

分 类 号：R651.15[医药卫生—外科学]