磁敏感加权成像在脑静脉畸形病变中的应用研究

Study on application of susceptibility weighted imaging in cerebral venous malformation

目的探讨磁敏感加权成像(SWI)技术在脑静脉畸形病变中的临床诊断价值。方法 20例经手术、数字减影血管造影(DSA)和(或)磁共振成像(MRI)和临床随诊等确诊为脑静脉畸形患者(6例合并海绵状血管瘤),均行常规序列MRI与SWI检查。比较和测算常规MRI序列及SWI所显示病灶数目与面积,并观察病灶的形态、信号特征等。结果常规MRI对部分髓静脉显示不清,部分呈条状低信号或高信号。CE-T1WI呈条状高信号影。T1WI及T2WI可见引流静脉,但髓静脉显示欠佳。增强T1WI及SWI均可见1条粗大引流静脉和多条纤细髓静脉,呈"根须"状,但SWI较增强T1WI显示更清晰。SWI对髓静脉检出率为100.00%(103/103),高于T1WI和T2WI的23.30%(24/103)、33.01%(34/103),且高于CE-T1WI的77.27%(51/66),差异具有统计学意义(P<0.05);SWI、T1WI、T2WI对引流静脉的检出率分别为100.00%(23/23)、69.57%(16/23)、73.91%(17/23);SWI与CE-T1WI对引流静脉检出率均为100.00%。其中SWI检出引流静脉中表浅静脉引流7例(35.0%),深部静脉引流8例(40.0%),深浅静脉同时引流4例(20.0%)。1例病变未发现明显引流静脉。结论在颅内静脉畸形病变的检查与诊断中, SWI较常规MRI序列具有明显优势,尤其是微小、多发病灶以及细小髓静脉显示,并可以对病灶的大小与出血等情况进行定量评价,并在不注射对比剂情况下实现以上目的 ,在脑静脉畸形病变的诊断与定量评价方面具有重要的临床应用价值。

Objective To discuss the clinical value of susceptibility weighted imaging(SWI) technique in the diagnosis of cerebral venous malformation. Methods A total of 20 cerebral venous malformation patients(6 cases with cavernous hemangioma) diagnosed by operation, digital subtraction angiography(DSA) and/or magnetic resonance imaging(MRI) and clinical follow-up all underwent conventional sequence MRI and SWI examination. The number and area of lesions showed by conventional MRI sequence and SWI were compared and measured, and the shape and signal characteristics of lesions were observed. Results Conventional MRI showed unclear part of the medullary vein, some showed low or high-signal bars, and CE-T1 WI showed high-signal bars. T1 WI and T2 WI showed drainage veins, but the medullary veins showed poor results. Enhanced T1 WI and SWI showed a large drainage vein and multiple slender medullary veins, showing a "root whisker" shape, but SWI showed more clearly than enhanced T1 WI. The detection rate of medullary veins by SWI was 100.00%(103/103), which was higher than 23.30%(24/103) and 33.01%(34/103) by T1 WI and T2 WI, and higher than 77.27%(51/66), the difference was statistically significant(P<0.05). The detection rate of drainage vein by SWI, T1 WI and T2 WI was 100.00%(23/23), 69.57%(16/23) and 73.91%(17/23) respectively, which were all 100.00% by SWI and CET1 WI. SWI detected 7 cases(35.0%) of superficial venous drainage, 8 cases(40.0%) of deep venous drainage, and 4 cases(20.0%) of deep and shallow venous drainage. No obvious drainage vein was found in 1 case. Conclusion In the examination and diagnosis of intracranial venous malformation, SWI has obvious advantages over conventional MRI sequences, especially in the display of small, multiple lesions and small medullary veins, and it can quantitatively evaluate the size of lesions and bleeding, and achieve the above purpose without injection of contrast agent. SWI has important clinical application value in the diagnosis and quantitative evaluation of cerebral venous malformation.