磁敏感加权成像及扩散加权成像在高血压颅内微出血中的临床价值

THE DIAGNOSTICAL VALUE OF DW IMAGING AND SW IMAGING IN HYPERTENSION BY CEREBRAL MICROBLEEDS

目的应用磁敏感加权(SWI)及扩散加权成像(DWI)技术检测高血压患者中脑微出血(CMBs)病变,评估SWI及DWI序列在检出高血压脑内微出血灶的临床价值。方法收集40例原发性高血压的患者,分为低危-中危组及高危-很高危组,同时收集同期40例健康成人作为对照组,共80例。二组均行颅脑常规磁共振、DWI及SWI检查。图像评价:对SWI及DWI显示CMBs的阳性率及CMBs数量进行统计学分析,对SWI及DWI序列上微出血灶数目与高血压患者平均收缩压相关性进行Spearman秩相关分析。结果高血压组中26例发现微出血病灶,对照组为5例;高血压组中脑微出血轻、中、重度均可见,对照组阳性病例中仅见轻度微出血灶;CMBs主要位于双侧基底节区及皮质-皮质下区。SWI与DWI检查序列中,对照组与高危-很高危组、低危-中危组与高危-很高危组微出血阳性率及微出血灶数目均有统计学意义(P<0.01);高血压患者微出血灶数目与患者平均收缩压成正相关。结论 SWI序列显示高血压患者CMBs优于DWI序列,对高血压患者怀疑脑内有微出血灶时,SWI序列因作为首选检查方法。

Objective To evaluate the clinic value of cerebral microbleeds in patients with hypertension by susceptibility weighted imaging（SWI）, diffusion weighted imaging and conventional FSE sequences. Methods The study sample was consisted of 40 patients and 40 cases healthy elderly population, were examined using SWI, DWI and conventional FSE sequences by GE 3.0 T MR machine with 32 tunnel HR head coil. According to the clinical conditions, patients with hypertension were divided into low/mild risk group and high/very high risk group. The frequency, numbers and locations of CMBs were analyzed by SWI and DWI. The value of SWI and DWI sequences in founding CMBs were compared. The relation of CMBs with common systolic blood pressure was analyzed. Statistical analysis was performed with SPSS statistical soft- ware. The Kruskal- Wallis test, Spearson test and Spearman correlation analysis were selected as statistical analysis. Results CMBs were founded in 26 eases patients with hypertension and 5 cases of healthy elder. Slight, moderate, severe microbleeds were founded in patients with hypertension. Only slight mierobleeds were seen in healthy population. Incidence and grade of microbleeds were significantly different in two groups. CMBs were detected on SWI and DWI sequences mainly located in the Cortico - subcortical region and bilateral basal ganglia area. On both SWI and DWI sequences, compared with the controls subjects and patients of low/mild risk group, positive rate and numbers of CMBs in high/very high risk group had sig- nificant increased （P^0.01）. The numbers of CMBs in patients with hypertension positively correlated with their common systolic blood pressure on both SWI and DWI sequences. Conclusion SWI sequence is much better than DWI with a higher sensitive. CMBs and should be as the first choice for patients with hypertension by cerebral microbleeds.