MR弥散加权成像检出脑微出血的临床应用价值

MR diffusion-weighted imaging in detection of cerebral microbleeds

目的对照磁敏感加权成像(SWI),探讨MR弥散加权成像(DWI)对脑微出血(CMBs)检出的临床应用价值。方法回顾2017年1月至2020年8月浙江中医药大学附属第一医院同时行头颅DWI和SWI序列扫描的123例患者,分别记录并比较各个序列(T1WI、T2WI、DWI、SWI)CMBs的检出病例数、病灶数目及病灶直径,并比较1.5T与3.0T MR扫描仪DWI对CMBs病灶数检出的差异。结果123例患者中SWI检出CMBs 44例1184处,DWI检出37例306处,T2WI及T1WI分别发现19例85处和16例50处。DWI与SWI、T1WI与T2WI检出病例数的差异均无统计学意义(均P>0.05),而DWI与T1WI、T2WI检出病例数比较差异有统计学意义(χ^2=10.606、7.491,均P<0.0083,Bonferroni校正),SWI与T1WI、T2WI检出病例数比较差异有统计学意义(χ^2=17.282、13.336,均P<0.0083,Bonferroni校正)。3.0T MR扫描仪DWI对CMBs病灶数的检出优于1.5T MR扫描仪(P<0.01)。当b=1000 s/mm^2时,DWI病灶相位编码方向上出现高信号磁敏感伪影共229处。结论常规扫描的DWI有助于脑微出血灶的检出,具有一定的临床应用价值。

Objective To evaluate the clinical application of MR diffusion-weighted imaging(DWI)in the detection of cerebral microbleeds(CMBs)by comparing susceptibility-weighted imaging(SWI).Methods A total of 123 patients who underwent brain DWI and SWI simultaneously in the First Affiliated Hospital of Zhejiang Chinese Medical University from January 2017 to August 2020 were retrospectively reviewed.Image analysis was performed by two radiologists who had been engaged in neuroimaging diagnosis for more than five years.The number of cases and CMBs,and diameter of CMBs in each sequence(T1WI,T2WI,DWI,SWI)were record and compared,and the difference of DWI by 1.5T and 3.0T MR in the detection of CMBs was compared.Results Among 123 patients,1184 CMBs were detected in 44 patients by SWI,306 CMBs were detected in 37 patients by DWI,only 85 CMBs in 19 patients were found by T2WI and 50 CMBs in 16 patients by T1WI.There was no statistical difference between SWI and DWI,and between T1WI and T2WI,while the differences among the remaining sequences were statistically significant(Bonferroni correction,P<0.0083).The detection of the number of CMBs by 3.0T MR DWI sequence was better than that by 1.5T MR(P<0.01).When b=1000 s/mm2,there were 229 CMBs with high signal magnetic sensitivity artifacts in the phase coding direction of DWI images.Conclusion DWI sequence in diary routine practice is conducive and valuable to the detection of CMBs.