磁敏感加权成像在显示脑梗死颅内动脉血栓的临床应用价值

Clinical Application of Susceptibility Weighted Imaging in Exhibiting Arterial Thrombosis in Ischemic Stroke

目的探讨磁敏感加权成像(SWI)在脑梗死患者颅内动脉血栓诊断中的临床应用价值。方法符合纳入标准的96例单侧脑梗死的患者(发病时间14 h^14 d,其中男64例,女32例,年龄37~85岁)均行颅脑MRI[T1WI、T2WI、T2液体衰减反转恢复(FLAIR)、扩散加权成像(DWI)、三维时间飞跃(3D-TOF)MRA和SWI]和CT平扫,分析SWI血管磁敏感征、FLAIR高信号血管征及CT动脉致密征;分别将三者与MRA显示的动脉血栓进行比较,判断其与MRA对显示动脉血栓的一致性,并计算Kappa值。通过敏感性、特异性、阴性预测值、阳性预测值分析SWI、FLAIR、CT对动脉血栓的诊断价值。结果 96例患者中,3D TOF MRA共显示49支脑动脉血栓,而SWI、FLAIR、CT阳性的例数分别为42、28、13例,SWI与MRA在显示动脉血栓方面具有良好一致性(Kappa值为0.855,P<0.05)。SWI、FLAIR和CT检出动脉血栓的敏感性分别为85.7%、57.1%、26.5%。结论 SWI对脑梗死患者颅内动脉血栓的诊断具有重要价值,在一定程度上能弥补FLAIR和CT的不足。

Objective To evaluate the clinical application value of susceptibility weighted imaging in diagnosis of arte rial thrombosis in ischemic stroke. Methods 96 cases of the isehemic stroke patients （64 men and 32 women, age range, 37 85 years, onset of symptoms, 14h 14d） were collected in the study according to the inclusion criteria. All patients underwent M RI and CT examinations. The MRI protocol included T1WI, T2WI, T2 FLAIR, DWI, 3D TOF MRA and SWI. The susceptibility vessel sign（SWI）, hyperintense vessel sign（FLAIR） and hyperdeuse arterial sign（CT） were analyzed and were respectively compared to corresponding arterial thrombosis of 3D TOF MRA, and the Kappa value was calculated. The sensitivity, specificity, negative predictive value, positive predictive value of each sign were also calculated. Results 49 cerebral arteries thromboses were demonstrated in all 96 patients on 3D TOF MRA. The sensitivity of the susceptibili ty vessel sign, hyperintense vessel sign and hyperdense arterial sign to detect arterial thrombosis were 85.7% （42/49） , 57.1% （28/49）, 26.5% （13/49）, respectively. There was consistency between susceptibility vessel sign on SWI and ar terial thrombosis on 3D TOF MRA （ Kappa value = 0. 855, P 〈 0.05 ）. Conclusion ISWI is valuable for diagnosing the cerebral arterial thrombosis in ischemie stroke.