磁敏感加权成像与常规二维梯度回波成像对轻型脑损伤评估价值的比较分析

Comparative analysis between susceptibility-weighted imaging and conventional T2＊-weighted spoiled phase gradient-echo imaging in detecting intracranial bleeds in patients with mild traumatic brain injury

目的 探讨磁敏感加权成像（susceptibility-weighted imaging,SWI）较常规二维梯度回波成像（T2^＊-weighted spoiled phase gradient-echo imaging,T2^＊ WI）对轻型创伤性脑损伤（mild traumatic brain injury,MTBI）颅内出血检出优势及其对MTBI的评估价值.方法 收集57例MTBI患者T2^＊ WI、SWI及临床资料,统计比较T2＊ WI与SWI检出出血灶阳性例数及出血灶数目差异,以及SWI与临床之间的关联.结果 SWI检出43例（75％）出血灶阳性,共237个病灶;T2^＊ WI检出32例（56％）出血灶阳性,共123个病灶.SWI检出病灶阳性人数明显多于T2^＊ WI（P＜0.01）;SWI检出出血灶数目明显多于T2＊ WI（P＜0.01）.35例有短暂昏迷史,其中22例随访发现脑损伤后综合征（post cerebral traumatic syndrome,PCTS）;22例外伤时意识清晰,其中10例随访发现PCTS.有昏迷史者SWI上检出出血灶比率明显高于无昏迷史者（86％：59％,P＜0.05）;SWI上出血灶阳性者随访发现PCTS的比率明显高于出血灶阴性者（65％：29％,P＜0.05）.结论 SWI比普通T2^＊ WI对MTBI出血灶的检出更敏感.出血灶的存在影响MTBI患者远期预后,SWI对此能提供客观信息.

Objective To investigate the advantages of susceptibility-weighted imaging （SWI） over conventional T2^＊-weighted spoiled phase gradient-echo imaging （T2^＊ WI） in detecting brain hemorrhage in patients with mild traumatic brain injury （MTBI） and its relationship to outcome after MTBI.Methods Clinical information,T2^＊ WI and SWI of 57 patients with MTBI were collected.Bleeding cases and number of cerebral micro-cerebral bleeds （MCBs） detected using T2^＊ WI and SWI were compared statistically.Correlation analysis between SWI and clinical outcome was performed.Results Hemorrhage in 43 patients （75%） with MCBs amounting to 237 was detected using SWI,while hemorrhage in 32 patients （56%） with MCBs amounting to 123 was found using T2^＊ WI （P〈0.01）.Thirty-five patients experienced short-term unconsciousness,including 22 being detected with post cerebral traumatic syndrome （PCTS） at follow-up.Twenty-two patients experienced no coma,among which 10 developed PCTS at follow-up.Based on the SWI,patients who experienced coma showed higher incidence of hemorrhage compared with patients who did not （86% vs 59%,P〈0.05）,and patients with hemorrhagic focus was associated with higher probability of PCTS compared with patients without （65% vs 29%,P〈0.05）.Conclusions SWI is more sensitive than conventional T2^＊ WI in detecting cerebral MCBs.MCBs are related to the late prognosis of MTBI patients,but SWI can supply certain valuable and objective information.