联合SWI与DWI在新生儿缺氧缺血性脑病中的应用价值

Susceptibility weighted imaging in combination with diffusion weighted imaging in the diagnosis of neonatal hypoxic-ischemic encephalopathy

目的探讨联合磁敏感加权成像(SWI)和弥散加权成像(DWI)在新生儿缺氧缺血性脑病(HIE)中的应用价值。方法回顾性分析36例经临床诊断为HIE患儿的磁共振图像,所有患儿均行常规MRI序列、SWI序列及DWI序列扫描,分别统计T1WI、T2WI、T2FLAIR、DWI、SWI所检出的病灶数目,并对不同序列病灶检出率进行χ2检验及χ2分割法两两比较。结果36例HIE患儿共检出病灶113个,其中T1WI 38个,T2WI 27个,T2FLAIR 62个,DWI 76个,SWI 82个;不同序列病灶检出率具有统计学差异(χ2=80.43,P<0.01);χ2分割法两两比较SWI病灶检出率分别高于T1WI(χ2=34.40,P<0.01)、T2WI(χ2=53.61,P<0.01)和T2FLAIR(χ2=7.66,P<0.01),SWI与DWI病灶检出率无明显差异(χ2=0.76,P=0.38);6例患儿完全依靠SWI检出(其它序列未检出)有颅内出血灶,3例患儿完全依靠DWI检出(其它序列未检出)有细胞毒性水肿。结论 SWI和DWI更容易检出HIE患儿的颅内病灶。SWI可更敏感的检出颅内出血灶,DWI能敏感显示早期细胞毒性水肿。联合应用SWI与DWI有助于更全面准确评价HIE患儿颅内病变程度。

Objective To study the value of susceptibility weighted imaging （SWI） in combination with diffusion weighted im-aging（DWI） in the diagnosis of neonatal hypoxic-ischemic encephalopathy（HIE） .Methods Analysize the MRI finidings of 36 cases of neonates with HIE diagnosed by clinical criteria in a retrospective way .All these neonates were selected to receive con-ventional MRI ,SWI and DWI sequence scan .Lesions were counted on T1WI ,T2WI ,T2FLAIR ,DWI ,SWI respectively .χ2 test and partitions of χ2 method were performed to compare the detection rate of lesions according to different sequences .Results A total of 113 lesions were detected by all the MRI sequences for 36 cases .The number of lesions detected was 38 ,27 ,62 ,76 and 82 respectively on T1 WI ,T2 WI ,T2 FLAIR ,DWI ,SWI .There had statistical difference for the detection rate of lesions on different sequences （χ2 =80.43 ,P〈0.01）;Through partitions of χ2 method ,the detection rate of lesions by SWI was signifi-cant higher than that of T1WI（χ2 =34.40 ,P〈0.01） ,T2WI（χ2 =53.61 ,P〈0.01） ,T2FLAIR（χ2 =7.66 ,P〈0.01） .There had no statistical difference for the detection rate of lesions by SWI and by DWI （χ2 =0.76 ,P=0.38） .Intracranial hemorrhages in 6 cases were detected by only SWI sequence（other sequence not detected） and cytotoxic edemas in 3 cases were detected by only SWI sequence（other sequence not detected） .Conclusion Intracranial lesions of neonates with HIE can be detected more easily by SWI and DWI .SWI has higher sensitivity in detecting intracranial hemorrhages .DWI has higher sensitivity in detec-ting ealy cytotoxic edemas .Combined application of SWI and DWI contribute to evaluate the seriousness of intracranial lesions in neonates with HIE more comprehensively and accurately .