1.5T磁共振弥散加权成像联合磁敏感加权成像在脑梗死与脑出血急性期鉴别诊断中的应用价值

Application value of 1.5T magnetic resonance DWI combined with SWI in differential diagnosis of cerebral infarction and acute cerebral hemorrhage

目的探讨1.5T磁共振弥散加权成像(DWI)联合磁敏感加权成像(SWI)鉴别诊断脑梗死与脑出血急性期的应用价值。方法选取2015年10月至2017年12月霍州市人民医院收治的60例脑梗死患者为A组,35例脑出血患者为B组,同时选取16名健康志愿者作为对照组,患者均行1.5T磁共振DWI和SWI检查,回顾性分析其影像学资料,分析两组检查结果。结果A组急性期SWI呈等信号;DWI呈高信号,且随着时间的推移,信号增强越明显,病灶边缘由模糊至清晰,阳性率为100%;B组急性期SWI呈均匀低信号,DWI血肿周围呈高信号,中心呈极低信号,且随着时间推移,周围信号逐渐增强;与对照组ADC值相比,B组明显降低,A组轻度降低,且随着时间的推移A组ADC值逐渐下降,B组水平基本保持不变;A组各个时间点ADC值较B组高,差异有统计学意义(P<0.05);B组PV值显著下降,A组PV值正常,但梗死后出血性转化时A组局部PV值有所下降,A组各个时间点PV值较B组高,差异有统计学意义(P<0.05)。结论脑出血与脑梗死急性期SWI和DWI影像学表现不同,而SWI和DWI联合应用,可快速鉴别和诊断急性脑血管疾病,有助于监测脑梗死后出血性转化,为临床治疗提供重要依据。

Objective To investigate the value of 1.5T magnetic resonance diffusion weighted imaging(DWI)combined with magnetic sensitive weighted imaging(SWI)in the differential diagnosis of acute cerebral infarction and cerebral hemorrhage.Methods Sixty cases of cerebral infarction treated in the People's Hospital of Huozhou from October 2015 to December 2017 were selected as group A,and 35 patients with cerebral hemorrhage were selected as group B,and 16 healthy volunteers were selected as control group.The patients were examined by 1.5T magnetic resonance DWI and SWI.The imaging data of the patients were analyzed retrospectively,and the results of the two groups were analyzed.Results In group A,SWI showed equal signal in acute phase,and DWI showed high signal,and as time went on,the signal enhancement was more obvious,the edge of the focus was blurred to clear,the positive rate was 100%.In group B,SWI showed uniform low signal,high signal around DWI hematoma,and very low signal in the center,and the surrounding signal gradually increased with time.Compared with the ADC value of the control group,the group B decreased significantly and the group A decreased slightly.And the ADC value of the group A decreased gradually and the level of the group B remained unchanged as the time went by,and the ADC value of the group A was higher than that of the group B at every time point(P<0.05).The PV value of the group B was significantly lower,but the hemorrhagic turn after infarction was normal.At the time of chemotherapy,the local PV value of group A decreased,while the PV value of group A was higher than that of group B at all time points(P<0.05).Conclusions The SWI and DWI imaging features of cerebral hemorrhage and cerebral infarction are different,and the combination of SWI and DWI can quickly identify and diagnose acute cerebrovascular diseases,and help to monitor hemorrhagic transformation after cerebral infarction and provide important basis for clinical treatment.