各向同性容积扫描增强技术对儿童化脓性脑膜炎的诊断价值

Diagnostic value of isotropic three-dimensional fast spin echo-CUBE enhancement sequence in children with purulent meningitis

目的通过比较增强各向同性三维快速自旋回波脉冲(3D-FSE-CUBE,简称CUBE)序列T1WI和增强FLAIR序列T2WI对化脓性脑膜炎(PM)脑膜增厚强化的显示能力,探讨增强CUBE序列T1WI对PM的临床应用价值。方法搜集首都医科大学附属北京儿童医院2016年8月至2017年1月,35例临床确诊为PM的患儿,其中男16例、女19例,年龄2个月至3岁,中位年龄8个月。所有患儿均行常规MR平扫及增强扫描,增强后对CUBE序列T1WI和FLAIR序列T2WI进行随机先后采集。以增强FLAIR序列T2WI为标准,评价增强CUBE序列T1WI序列对硬脑膜和柔脑膜增厚的显示率,将强化灶的检出数目采用四格表χ2检验。结果增强FLAIR序列T2WI可显示21例硬脑膜强化,显示率为60.0%;增强CUBE序列T1WI可显示31例硬脑膜强化,显示率为88.6%;两者间差异具有统计学意义(χ2=6.058.P<0.01);增强FLAIR序列T2WI可显示16例柔脑膜强化,显示率为45.7%;增强CUBE序列T1WI可显示19例柔脑膜强化,显示率为54.3%;增强CUBE序列T1WI对柔脑膜强化显示较增强FLAIR序列T2WI更清晰,但两者间差异无统计学意义(χ2=0.229,P>0.05)。结论增强CUBE序列T1WI对脑膜增厚强化的显示优于增强FLAIR序列T2WI,对于儿童PM的诊断有较大的临床应用价值。

Objective To explore the clinical value of 3D fast spin echo with an extended echo train acquistion (CUBE) T1WI enhancement sequence for purulent meningitis by comparing to contrast-enhanced T2WI-FLAIR sequence in the detection of lesions. Methods From August 2016 to July 2017,children with clinically suspected purulent meningitis underwent cranial magnetic resonance examination in our hospital.There were 35 children,19 males and 16 females,aged 2 months to 3 years (median age 8 months) in total.A GE Discovery MR 750 3.0 T scanner was used to perform routine plain and enhanced scan in all children. After enhancement,the sequences of CUBE T1WI and FLAIR T2WI were applied randomly. Using the FLAIR T2WI enhancement sequence as the reference,we evaluated the detection rate of CUBE T1WI enhancement sequence for dura mater and leptomeningeal thickening. The number of enhanced lesions detected was tested by χ2 test. Results The enhanced FLAIR T2WI sequence showed 21 cases with dural enhancement,showing a rate of 60.0%. The enhanced CUBE T1WI sequence showed 31cases with dural enhancement,showing a rate of 88.6%. There were significant differences between the dural lesions detected (χ2=6.058,P<0.01).The enhanced FLAIR T2WI sequence showed 16 cases of leptomeningeal enhancement,showing a rate of 45.7%. The enhanced CUBE T1WI sequence showed19 cases of leptomeningeal enhancement,showing a rate of 54.3%.The enhanced CUBE T1WI sequence was not significantly higher than that of enhanced T2WI-FLAIR sequence in displaying leptomeningeal enhancement (χ2=0.229,P>0.05). Conclusion Enhancement of the CUBE T1WI sequence enables better visualization of meningeal thickening than FLAIR T2WI.It has great clinical value in the diagnosis of purulent meningitis in children.