三维容积液体衰减翻转恢复序列在神经精神狼疮中的临床价值

Clinical value of three-dimensional fluid attenuated inversion recovery sequence in neuropsychiatric systemic lupus erythematosus

目的通过与常规二维MR序列(T1W、T2W、T2FLAIR)比较,探讨三维容积液体衰减翻转恢复序列(3D-FLAIR)在神经精神狼疮(NPSLE)脑部病变中的应用价值。方法对28例具有脑脊液化验结果的NPSLE患者行T2W、T2FLAIR、3D-FLAIR轴位平扫,在T1W增强扫描后24～48h内行T1W及3D-FLAIR轴位、矢状位、冠状位增强扫描。在轴位平扫图像统计脑内直径<6mm病灶的数量,在增强图像评估有无脑膜病变强化及脑膜病变的强化范围。结果28例患者中,25例头部扫描发现异常。25例患者T2W、T2FLAIR、3D-FLAIR分别发现脑内直径<6mm异常信号灶为183、213、307个,三者总数的差异有统计学意义(P<0.001),组间比较显示T2W与3D-FLAIR、T2FLAIR与3D-FLAIR差异均有统计学意义(P均<0.001),T2W与T2FLAIR差异无统计学意义(P=0.89)。28例患者中,16例脑脊液腰穿结果存在异常,其中T1W、3D-FLAIR增强扫描分别发现脑膜病变强化5例、12例,敏感度分别为31.25%(5/16)、75.00%(12/16),差异有统计学意义(P<0.05)。7例NPSLE患者在3D-FLAIR增强发现脑膜局灶性强化,而在T1W增强未见确切强化。5例NPSLE患者T1W增强发现脑膜病变强化,对比相同层面的3D-FLAIR图像,两者脑膜异常强化范围评分差异有统计学意义(P<0.05)。结论3D-FLAIR序列能较T2W、T2FLAIR发现更多直径<6mm的异常信号灶。在发现NPSLE脑膜异常改变方面,3D-FLAIR增强扫描较常规T1W增强扫描具有优势。

Objective To investigate the clinical value of three-dimensional fluid attenuated inversion recovery sequence （3D-FLAIR） in detecting brain lesions of neuropsychiatric systemic lupus erythematosus （NPSLE）, and compare with con- ventional two-dimensional magnetic resonance sequences （T1W, T2W, T2 FLAIR）. Methods Twenty-eight NPSLE pa- tients with cerebrospinal fluid test results underwent T2W, T2 FLAIR, 3D-FLAIR plain axial scans and T1W, 3IYFLAIR （in 24-48 h after TIW enhanced scan） axial, sagittal, coronal enhanced scans, subsequently. Two independent radiolo- gists made the statistics about the total numbers of brain lesions less than 6 mm in diameter on the three plain axial scan se- quences and analyzed whether there were meningeal lesions enhancement, as well as the range of meningeal lesions enhance- ment on the enhanced images. Results Abnormalities were detected in 25 patients. The number of focal lesions with diam- eter less than 6 mm detected with T2W, T2 FLAIR, 3D-FLAIR was 183, 213, 307 in 25 patients, respectively （P〈 0. 001）. The numbers of the lesions detected between T2W and 3D-FLAIR, T2 FLAIR and 3D-FLAIR had statistical difference （both P〈0. 001）, while no statistical difference was found between T2W and T2 FLAIR （P=0.89）. Sixteen patients presented abnormal cerebrospinal fluid results in all 28 patients. Meningeal lesions enhancement had been detected in 5 and 12 patients in TIW, 3D-FLAIR enhancement scan, and the sensitivity was 31.25% （5/16） and 75.00% （12/16）, respectively （P〈0.05）. Focal meningeal abnormal enhancement was detected in 7 NPSLE patients in 3D-FLAIR, but neg- ative in T1W enhanced scan. There was statistical difference in the score of meningeal lesions enhancement range between T1W and corresponding 3D-FLAIR images in 5 NPSLE patients （P〈0.05）. Conclusion Compared with T2W and T2 FLAIR, 3D-FLAIR can detect more abnormal signal focal lesions in brain. Enhanced 3D-FLAIR is superior to enhanced T1W in detecting meningeal lesions in NPSLE patients.