磁敏感加权成像技术在脑出血早期诊断及病因判断中的临床应用价值

Clinical application of susceptibility-weighted imaging in the early diagnosis and analysis of the causes of cerebral hemorrhage

目的探讨磁敏感加权成像技术(SWI)在脑出血早期诊断及病因判断中的临床应用价值。方法筛选急性期脑出血患者(30例),常规行头颅CT、磁共振成像(MRI)常规序列(TlWI、T2WI、FLAIR、DWI)、磁共振血管造影(MRA)及SWI序列,统计分析患者脑出血病灶范围、病灶数量、病因检出率,评价SWI对脑出血早期诊断的敏感性及准确性。结果 SWI检出出血病灶39个,检出率为100.00%;常规MRI序列检出出血病灶31个,检出率为79.48%;CT检出出血病灶27个,检出率为69.23%;三种方法出血病灶检出率比较差异具有显著性(P<0.05)。SWI序列显示出血范围较MRI常规序列、头颅CT略大。SWI检出脑淀粉样变性2例,海绵状血管瘤1例,静脉畸形1例,动静脉畸形1例;MRI常规序列漏诊静脉畸形和淀粉样变性患者3例,头颅CT未能检出脑出血特殊病因患者5例。MRA检出有不同程度颅内动脉粥样硬化患者22例。结论 SWI序列与头颅CT、MRI常规序比较,能够更准确地检测脑出血病灶及出血范围,同时能够更敏感地检测脑出血的少见病因。MRI联合MRA及SWI能够为脑出血的早期病因诊断提供更多、更准确的信息,是急性期脑出血的最佳检查手段。

Objective To evaluate the clinical application of sensitive weighted imaging（SWI） in the early diagnosis and analysis of the causes of cerebral hemorrhage. Method 30 patients with acute cerebral hemorrhage underwent computed tomography（CT） magnetic resonance imaging scan（T1WI, T2 WI, DWI and FLAIR）, magnetic resonance angiography（MRA） and SWI. Analyzed the respective signal characteristics and characteristics of distribution, and recognized differences between the detection rate and volume of each series, and compared the relevance among the detection numbers and volume of SWI, MRI, MRA, and CT in order to evaluate the sensitivity and accuracy evaluation of SWI in the early diagnosis of cerebral hemorrhage. Result 39 lesions in SWI were observed and the detection rate was 100.00%; 31 lesions in MRI were observed, and the detection rate was 79.48%; 27 lesions in CT were observed, and the detection rate was 69.23%. There were significant difference in detection rate of the lesions between CT, MRI and SWI（P〈0.05）. Among the 30 cases with cerebral hemorrhage, brain amyloidosis（n = 2）, cavernous hemangioma（n = 1）, venous malformation（n = 1）, arteriovenous malformation（n = 1） were all showed clearly on SWI images. 3 cases of venous malfornlations and brain amyloidosis were not shown by routine MRI, and 5 cases of brain amyloidosis, cavernous hemangioma, venous malformation and arteriovenous malformation were not shown by CT. Conclusion SWI could obviously demonstrate the cerebral microbleeds and lesion volume more than routine MRI imaging sequences and CT, meanwhile it could be more sensitive in analysis of the causes of cerebral hemorrhage. MRI combined with MRA and SWI could provide more accurate information for the early diagnosis and analysis of the causes of cerebral hemorrhage, and is the best screening methods for patients with cerebral hemorrhage in acute stage.