磁敏感加权成像技术在脑微出血诊疗中的临床应用价值

Clinical application value of magnetic susceptibility weighted imaging in diagnosis and treatment of cerebral microbleeds

目的探讨磁敏感加权成像(SWI)在脑微出血(CMBs)影像诊断中的价值,以及对临床应用溶栓药物治疗脑梗死可能出现的脑出血潜在危险的预见性。方法采用MR扫描仪,对182例临床有症状的患者进行常规磁共振头颅平扫T1WI、T2WI、T2FLAIR、DWI序列及SWI序列扫描,比较各序列对于脑微出血灶数量、部位、分布的显示情况,并进行统计学分析。结果 182例患者中24例存在脑内微出血,SWI序列共检出CMBs病灶172个;T1WI、T2WI、T2FLAIR以及DWI序列检出CMBs病灶的数目分别为16(9.3%)、30(17.4%)、35(20.3%)、18个(10.5%),各序列中CMBs病灶检出的数目比较,差异有统计学意义(P<0.05)。SWI序列与T1WI、T2WI、T2FLAIR、DWI序列CMBs检出敏感性比较,差异有统计学意义(P<0.05)。7.0%微出血病灶分布于脑干,4.7%分布于小脑,27.3%分布于丘脑,37.8%分布于基底节区,23.3%分布于皮层及皮层下。结论 SWI序列对CMBs的检出敏感性高于常规序列,为目前检出CMBs的最佳序列,对脑卒中的治疗及预后判断具有较为重要的临床应用价值。

Objective To explore the value of MR susceptibility weighted imaging（SWI） in diagnosis of cerebral microb leeds（CMBs）,as well as the predictability of the potential danger of recurrent bleeding due to the treatment of cerebral in farction with thrombolytic medicine.Methods Conventional MR sequences including T1WI,T2WI,T2FLAIR and DWI sequences were performed in 182 patients as well as SWI sequence.The quantity,location and distribution of the cerebral microbleeds in all MRI sequences were compared and statistically analyzed.Results 24 in 182 cases had CMBs with a total of 172 CMBs lesions by SWI sequence detection.The detection numbers of CMBs lesions by T1WI,T2WI,T2FLAIR and DWI sequences were 16（9.3%）,30（17.4%）,35（20.3%）,18（10.5%）.There were statistic differences in the detection numbers of CMBs lesions among those sequences（P0.05）.The CMBs detection sensitivity was compared among SWI and T1WI,T2WI,T2FLAIR and DWI sequences,the differences were statistically significant（P0.05）.The locations of microbleeds in brainstem accounted for 7.0%,cerebellum accounted for 4.7%,thalamus accounted for 27.3%,basal ganglia accounted for 37.8%,cortex and subcortex accounted for 23.3%.Conclusion SWI has higher detection rate than conventional MRI sequences in CMBs detection.This technique is so far the best sequence in detection of cerebral microbleeds.SWI provides important reference for cerebral infarction treatment and evaluation of cerebral infarction prognosis.