ESWAN序列对弥漫性轴索损伤出血性剪切灶的检出及临床相关分析

Diffuse Axonal Injury:Clinical Correlation with Microbleeds Visualized By ESWAN Sequence

目的通过多回波采集的重度T2*加权三维梯度回波序列(enhanced T2star weighted angiography,ES-WAN)对剪切出血灶的检出结果与弥漫性轴索损伤(diffuse axonal injury,DAI)相关体征如格拉斯哥昏迷量表(glas-gow coma scale,GCS)评分、昏迷时间以及瞳孔对光反射的相关性分析进一步评估ESWAN序列对DAI的诊断价值。方法 28例DAI患者入选本研究。采用ESWAN序列检出全脑出血灶和分区出血灶的数量、容积。分别按GCS评分、昏迷时间及瞳孔对光反射分组,对组间的全脑出血灶及分区出血灶的数量、容积采用秩和检验,检验其差异性。作全脑出血灶及分区出血灶的数量、容积与临床指标分级变量间的相关分析。结果 GCS评分较低组(≤8,n=16)、昏迷时间较长组(>4天,n=15)以及瞳孔对光反射有异常组(n=15)的全脑(P≤0.01)及额叶白质区、颞顶枕叶白质区、胼胝体、丘脑和脑干的分区(P≤0.05)出血灶数量和表观容积均明显增高。全脑出血灶的数量和表观容积与临床指标的分级变量间有显著的相关性(Spearman相关系数的绝对值变化范围为0.57～0.77)。额叶白质区、颞顶枕叶白质区、胼胝体、丘脑和脑干的分区出血灶数量和表观容积也和临床指标间有明显的相关性(Spearman相关系数的绝对值变化范围为0.44～0.83)。结论 ESWAN序列不仅能敏感检出DAI出血性剪切灶,而且其显示的结果与患者的有关意识障碍的临床指标有显著的相关性,是一项能有效、可靠地评估DAI出血灶的新的影像学方法。

Objective To assess the diagnostic value of ESWAN sequence for diffuse axonal injury（DAI） by virtue of correlation analysis between the number,volume of microbleeds determined with ESWAN sequence and clinical variables such as initial Glasgow Coma Scale（GCS） score,duration of coma and pupillary light reflex.Methods Twenty eight DAI patients were included in our study and were divided into subgroups in compliance with dichotomized clinical variables separately.Global and regional number,volume of microbleeds were compared between groups by nonparametric Mann-Whitney U test（two-tailed）.Spearman’s rank correlation analysis also was performed to compare the dichotomized clinical variables with the global and regional number and volume of lesions.Results Patients with lower GCS score（≤8,n=16） or prolonged coma（〉4 days,n=15） abnormal pupillary light reflex（n=15） had a greater global number（P≤0.01） and apparent volume（P≤0.01） of microbleeds.In our study,hemorrhage extent in each brain region was greater in the lower GSC group（P≤0.05）,in the prolonged coma group,in the abnormal pupillary light reflex group with the exception of FG（frontal gray matter,FG）,PTOG（parietotemporaloccipital gray matter,PTOG）,cerebellum and basal ganglia.Significant correlations were found between hemorrhage extent in global range and the dichotomized clinical variables（The absolute values of Spearman correlation coefficient range from 0.57 to 0.77）.Correlations were also found between hemorrhage extent in all regions and the dichotomized clinical variables（The absolute values of Spearman correlation coefficient range from 0.44 to 0.83）with the exception of FG,PTOG,cerebellum and basal ganglia.Conclusion More accurate and objective assessment of injury can be obtained in DAI patients via ESWAN sequence.The results of ESWAN sequence have significant correlation with the clinic index about consciousness disoeders.