磁敏感加权成像对重度出血性弥漫性轴索损伤的诊断价值和预后评价

Susceptibility weighted imaging in diagnostic and prognostic evaluation of severe hemorrhagic diffuse axonal injury

目的探讨磁共振磁敏感加权成像对重度出血性弥漫性轴索损伤(DAI)的诊断价值与临床病情严重程度、预后评价之间的关系。方法回顾分析2013年12月至2015年12月吉林大学第一医院神经创伤外科收治的30例重度出血性弥漫性轴索损伤患者的CT及磁共振T1加权成像(T1WI)、T2加权成像(T2WI)、液体衰减反转恢复(FLAIR)、DWI、磁敏感加权成像(SWI)序列扫描结果,比较SWI序列同其他各序列对重度弥漫性轴索损伤出血性病灶的检出数量,并与GCS评分和GOS评分进行相关性分析。结果 SWI较其他序列及CT能更精准地显示脑内出血病灶,差异有统计学意义(P<0.05),其次分别是DWI、FLAIR、T2WI、T1WI和CT。SWI和DWI检出出血病灶数量与入院时的GCS评分及出院后随访的GOS评分之间呈负相关,差异有统计学意义(P<0.05),且SWI的相关性更好;CT和FLAIR、T2WI、T1WI序列检出病灶的数量分别与入院时的GCS评分呈负相关,差异有统计学意义(P<0.05),但与GOS评分之间不具有相关性,差异无统计学意义(P>0.05)。结论 SWI序列能非常敏感而有效地检出重度出血性弥漫性轴索损伤患者的脑内微出血病灶,进而为重度出血性DAI的早期临床诊治及预后评估提供更多帮助。

Objective To assess the diagnostic value of susceptibility weighted imaging （SWI） for severe hemorrhagic diffuse axonal injury （DAI） and their correlation with evaluation of iniury severity and outcome. Methods Thirty patients with clinically diagnosed severe hemorrhagic DAI, from December 2013 to December 2015 in Department of Neurotrauma, First Hospital of Jilin University, underwent CT, routine T1 weighted imaging （T1WI）, T2 weighted image （T2WI）, fluid attenuated inversion recovery （FLAIR）, DWI and SWI scanning. Respective signal characteristics and distribution features were detected.Number of DAI lesions detected in each sequence were compared and analyzed for correlation with GCS and GOS. Results By contrast, SWI provided relatively better detection of intracranial micro-hemorrhage lesions （P〈0.05）, and then DWI, FLAIR, T2WI, T1WI, CT. Lesion numbers on SWI and DWI were negatively correlated with GCS on admission and GOS at follow-up （P〈0.05）, moreover SWI had the better correlation. Lesion numbers on FLAIR, T2WI, T1WI and CT suspectively were negatively correlated with GCS on admission ,but were not correlated with GOS at follow-up（P〉 0.05）. Conclusion SWI can be pretty sensitive and effective to detect intracranial micro-hemorrhage lesions in severe hemorrhagic DAI patients and therefore supply more help for early diagnosis and treatment of severe hemorrhagic DAI as well as prognosis evaluation.