磁敏感加权成像检测糖尿病患者脑微出血及其与认知功能的相关性

Correlation between cerebral microbleeds detected by susceptibility-weighted imaging and cognitive function in diabetics

目的探讨磁敏感加权成像（SWI）检测糖尿病患者脑微出血（CMBs）的临床价值及其与认知功能的相关性。方法根据蒙特利尔认知量表（MoCA）评分,将51例糖尿病患者分为两组,其中≥26分为认知正常组,〈26分为认知障碍组。对两组患者均行颅脑MR T2WI及SWI检查,观察CMBs的发生部位、大小和数量。并对SWI检出的CMBs病灶进行评级,其中0级无病灶,1级1-4个病灶,2级5-9个病灶,3级≥10个病灶。比较两种方法CMBs的检出率、病灶直径的差异及两组患者间CMBs分级的差异,分析CMBs病灶数与MoCA评分的相关性。结果 51例中,SWI检出19例CMBs,T2WI检出5例CMBs。SWI的检出率高于T2WI（P〈0.05）。两种方法所测病灶直径差异无统计学意义（P〉0.05）。SWI共发现CMBs病灶109个,位于皮层-皮层下56个（56/109,51.38%）,基底核-丘脑37个（37/109,33.94%）,脑干9个（9/109,8.26%）,小脑7个（7/109,6.42%）。CMBs分级为0级32例（32/51,62.74%）,1级9例（9/51,17.65%）,2级6例（6/51,11.76%）,3级4例（4/51,7.84%）。两组患者间CMBs分级差异有统计学意义（χ^2=21.24,P〈0.001）。糖尿病患者CMBs病灶数与MoCA评分呈负相关（r=-0.790,P〈0.001）。结论 SWI是检出糖尿病患者CMBs病灶较为敏感的影像学方法,有助于对糖尿病患者认知功能状态的临床评估。

Objective To explore the clinical value of susceptibility-weighted imaging（SWI） in detecting cerebral microbleeds（CMBs）of diabetes patients and its correlation with cognitive function.Methods Fifty-one patients with diabetics were divided into two groups according to scores of Montreal Cognitive Assessment（MoCA） scoring criteria.Patiens with MoCA scores ≥26 were considered as normal cognition group and thoses with MoCA score 26 were considered as cognitive impairment group.T2 WI and SWI were performed on all the patients.The location,size,and number of CMBs were observed.CMBs detected by SWI were classified as follows：Grade 0（0 lesion）,grade 1（1—4 lesions）,grade 2（5—9 lesions） and grade 3（≥10 lesions）.The detecting rate and diameter of CMBs lesions obtained by T2 WI and SWI were compared.CMBs classifications of the two groups were also compared.And the correlation between the number of CMBs and MoCA scores was analyzed.Results CMBs were detectable in 19 cases by SWI and in 5 cases by T2 WI.The detecting rate of SWI was higher than that of T2WI（P〈0.05）.No statistical difference was found in diameter of the lesions between the two groups（P〈0.05）.Totally 109 CMBs lesions were found by SWI,including 56 lesions in cortical-subcortical region（56/109,51.38%）,37 lesions in basal ganglia-thalamus（37/109,33.94%）,9 lesions in brainstem（9/109,8.26%） and7 lesions in cerebellum（7/109,6.42%）.CMBs classification was grade 0 in 32 cases（32/51,62.74%）,grade 1 in 9 cases（9/51,17.65%）,grade 2 in 6 cases（6/51,11.76%） and grade 3 in 4 cases（4/51,7.84%）,respectively.There was statistical difference in CMBs classifications between the two groups（χ^2=21.24,P〈0.001）.The number of CMBs lesions correlated negatively with MoCA scores in diabetics patients（r=—0.790,P〈0.001）.Conclusion SWI achieves a relatively high sensitivity in detecting CMBs of patients with diabetics,which is helpful for the clinical assessment of cognitive function status.