SWAN联合DWI在急性脑弥漫性轴索损伤中的应用价值

Application of T_2 star weighted angiography combined with diffusion weighted imaging in diagnosing acute diffuse axonal injury

目的:探讨磁敏感加权成像(T2star weighted angiography,SWAN)联合弥散加权成像(diffusion weighted imaging,DWI)在急性脑弥漫性轴索损伤(diffuse axonal injury,DAI)中的诊断价值。方法:回顾性分析31例DAI患者的磁共振影像资料,包括常规T1WI、T2WI、液体衰减反转恢复(T2FLAIR)序列、DWI和SWAN序列,分别比较各序列对DAI非出血性和出血性病灶的检出数目,并分析其分布特点和信号特征。结果:共检出380个DAI病灶,主要分布在脑组织异质性较大的区域,如皮髓交界区、基底节、胼胝体、脑干及小脑等区域。DWI及SWAN分别对DAI非出血性病灶和出血性病灶检出明显优于其他序列,统计学分析有显著性差异(P<0.05)。病灶分布的区域与患者的病情严重程度及预后有相关性。结论:SWAN联合DWI序列的运用能够明显提高DAI出血性病灶及非出血性病灶的检出率,为临床早期诊断、早期治疗以及病变的预后提供可靠的影像学依据,可作为MRI检查DAI的常规及首选序列。

Objective To investigate the value of T2 star weighted angiography（SWAN） in combination with diffusion weighted imaging（DWI） in the diagnosis of acute diffuse axonal injury（DAI）. Methods The MRI data of 31 cases with DAI proved by clinical manifestation and imaging were analyzed retrospectively. All the patients underwent MRI examination with T1 WI, T2 WI,fluid attenuated inversion recovery（T2FLAIR）, DWI and SWAN sequences. The detected number of lesions was compared among the different sequences. The characteristics of signal and distribution of lesions were analyzed. Results A total of 380 lesions were detected by all the MRI sequences. DAI lesions were located in the white matter, corpus callosum, junctionnal zone of cortex and medulla, lateral dorsal brainstem, basal ganglia and cerebellum. DWI and SWAN respectively on non hemorrhagic lesions and hemorrhagic lesions detection rate and signal intensity were superior to other sequences. It was also significantly different（P〈0.05）. Conclusion SWAN combined with DWI sequence greatly improves DAI lesion detection rate and diagnostic accuracy, and provides a reliable imaging evidence for the early diagnosis, early treatment and prognosis of lesions, which should be used as the routine and preferred MR sequence for the diagnosis of DAI.