脑弥漫性轴索损伤的临床特征和MRI、CT诊断(附47例分析)

The Clinical Feature and the Diagnostic Value of MRI and CT in Diffuse Axonal Injury-Analysis of 47 Cases

目的探讨脑弥漫性轴索损伤(Diffuse Axonal Injury,DAI)的临床特征以及MRI、CT的诊断价值。资料与方法搜集经临床及MRI证实的47例DAI的临床及影像资料回顾性分析。所有患者均在伤后接受CT与MRI检查。MRI采用T1WI、快速自旋回波(FSE)T2WI、T2液体衰减反转恢复序列(T2-FLAIR)、弥散加权成像(DWI)。CT采用常规程序扫描。比较CT及MR各序列脑内病灶的显示率,分析其临床及影像表现特征。结果 47例DAI患者经MRI均发现脑实质非出血性挫裂伤及小出血灶,T2-FLAIR和DWI序列共发现DAI病灶535个,主要分布在皮髓交界区、脑干、胼胝体、基底节、丘脑及小脑,其中T2-FLAIR显示病灶但DWI显示为阴性的病灶数共45个,而DWI显示病灶但T2-FLAIR显示为阴性的病灶数共21个。47例患者中,MRI共检出514个病灶,CT仅检出95个病灶,两者差异显著(P<0.01)。MRI见2例合并颈椎骨质水肿及颈髓损伤水肿。结论 MRI对DAI具有较高的诊断价值,联合T2-FLAIR和DWI可以提高DAI病灶的检出率,对具有典型DAI临床特征而CT检查未发现DAI者,应尽早MRI检查,以弥补CT的局限性,对临床早期诊断以及治疗和预后具有重要价值。

Objective To assess the value of MRI and CT in diagnosis of diffuse axonal injury （DAI） and analyze its clinical feature.Materials and Methods 47 cases of DAI, which were diagnosed according to clinical manifestations and MRI findings, were collected for retrospective study. All patients had undergone MRI and CT. MRI employed T1WI, T2WI, T2-FLAIR and DWI; CT applied routine serial scanning. The detection rate of cerebral DAI lesions was compared between CT and the sequences of MRI, and its clinical and imaging features were analyzed.Results At the early stage of the disease, Total 535 lesions of non-hemorrhagic or Speckled hemorrhage were detected by combination of T2-FLAIRand DWI in all 47 cases. single or multiple focal lesions in white matter of brain, mainly located in the junctional zone of cortex and medulla, brain stem, corpus callosum, basal nodal region, interbrain and cerebellum. 45 lesions were identified by T2-FLAIR and were not detected by DWI, 21 lesions were identified by DWI and were not detected by T2-FLAIR. Of the 47 cases, MRI found out 535 lesions and CT told 95（P〈0.01）. 2 cases with cervical cord injury and cervical vertebra edema were proved with MRI.Conclusion MRI is of great value for the diagnosis of DAI. Combination of T2-FLAIR and DWI can improve detection ratio for diffuse axonal injury lesions. The DAI with typical clinic features, which didn＇t detected on CT, should be assess on MRI as early as possible. It can be considered as a supplement to CT scans and may provide useful information for early diagnosis,treatment protocol selection and prognosis.