磁敏感序列分析和常规MRI检查对脑血管淀粉样变脑出血诊断价值比较

Comparison of diagnostic values between magnetic susceptibilityweighted imaging and routine MRI in patients with cerebral amyloid angiopathy-related hemorrhage

目的:分析脑血管淀粉样变脑出血(CAAH)患者磁敏感序列分析(SWI)检查特征,阐明SWI在CAAH诊断中的临床价值。方法:选择68例临床诊断怀疑CAAH的患者,均予以常规磁共振成像(MRI)和SWI检查,比较2种影像学检查对怀疑CAAH患者出血病灶检出率的差异,分析2种影像学检查对CAAH检出情况一致性。应用多因素Logistic回归分析术前SWI的影像学特征与患者发生病灶出血的危险性。结果:经病理检查确诊为CAAH 61例,常规MRI序列检出CAAH病灶53个,检出率为86.89%;SWI序列检出CAAH出血病灶59个,检出率为96.72%,SWI显示出血灶数目明显多于常规MRI序列,2种影像学方法对CAAH病灶检出率比较差异有统计学意义(P<0.05)。SWI序列对CAAH患者的检出情况与MRI序列检出一致性较差,Kappa=0.366 6。多因素Logistic回归分析,斑片状高信号、多发边缘清低信号区是CAAH的相关性特征(OR=3.895,P=0.025;OR=3.124,P=0.029)。结论:SWI能有效检出CAAH出血病灶,且诊断价值优于常规MRI检查。

Objective：To analyze the imaging features of magnetic susceptibility-weighted imaging（SWI）in the patients with cerebral amyloid angiopathy-related hemorrhage（CAAH）,and to clarify the diagnostic value of SWI for CAAH.Methods：A total of 68 patients presumptively diagnosed as CAAH were collected,and their imaging data of routine MRI and SWI were collected and analyzed.The detection rates of hemorrhage focus of the CAAH patients were compared between two kinds of imaging examination.The consistency of detection of CAAH by routine MRI and SWI was analyzed.The imaging features of SWI and the risk of focus hemorrhage in the patients with CAAH were analyzed by multivariate Logistic regression analysis.Results：Sixty-one patients were confirmed as CAAH by pathologic diagnosis,and 53 patients were confirmed as CAAH by routine MRI;the detection rate was86.89%;59cases of hemorrhage focus were confirmed by SWI and the detection rate was 96.72%.The number of lesions detected by SWI was more than that of routine MRI（P〈0.05）.The consistency of detection of CAAH by routine MRI and SWI was poor,and the value of Kappa was 0.3666.The patchy high signal and multiple clear edge low signal area were the relative imaging features of CAAH with SWI in the patients with CAAH analyzed by multivariate Logistic regression analysis（OR=3.895,P=0.025;OR=3.124,P=0.029）.Conclusion：SWI can efficiently detect the hemorrhage focus in the patients with CAAH and the diagnostic value is better than routine MRI.