磁敏感加权成像在颅内硬脑膜动静脉瘘中的应用

Application of susceptibility-weighted imaging in intracranial dural arteriovenous fistula

目的探讨磁敏感加权成像(susceptibility-weighted imaging,SWI)在颅内硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)诊断中的应用价值。方法回顾性纳入2014年1月至2021年1月期间在威海市立医院经数字减影血管造影(digital subtraction angiography,DSA)证实为DAVF患者。所有患者均进行常规T1加权成像、T2加权成像和SWI检查,部分患者还进行三维时间飞跃磁共振血管成像(3D time of flight magnetic resonance angiography,3D-TOF-MRA)检查。结果共纳入36例DAVF患者,其中29例行3D-TOF-MRA。24例(24/36,66.7%)SWI和26例(26/29,89.7%)3D-TOF-MRA瘘口位置判断准确,前者显著低于后者(Fisher精确检验P=0.039)。SWI显示供血动脉增粗的患者比例(7/36,19.4%)显著低于3D-TOF-MRA(14/29,48.3%;χ^(2)=6.105,P=0.013)。在7例DSA显示不伴皮质静脉回流的DAVF患者中,T2加权成像、3D-TOF-MRA及SWI均显示无脑静脉异常;在29例DSA显示伴皮质静脉回流的DAVF患者中,29例(100%)SWI、26例(89.7%)T2加权成像显示浅静脉扩张,但二者差异无统计学意义(χ^(2)=0.693,P=0.405)。17例(47.2%)SWI显示髓静脉扩张,T2加权成像仅显示2例(5.6%)有少数髓静脉增粗,前者显著高于后者(P<0.001)。T2加权成像显示静脉性脑梗死的患者比例显著高于SWI(22.2%对0%;Fisher精确检验P=0.005),SWI显示脑内出血灶的患者比例显著高于T2加权成像(61.1%对25.0%;χ^(2)=9.574,P=0.004)。结论SWI有助于评价DAVF的引流静脉异常及脑内继发改变,特别是脑内出血。

Objective To investigate the application value of susceptibility-weighted imaging(SWI)in the diagnosis of intracranial dural arteriovenous fistula(DAVF).Methods Patients with DAVF confirmed by digital subtraction angiography(DSA)in Weihai Municipal Hospital from January 2014 to January 2021 were retrospectively included.All patients underwent conventional T1-weighted imaging(T1WI),T2-weighted imaging(T2WI)and SWI,and some patients also underwent 3D time-of-flight magnetic resonance angiography(3D-TOF-MRA).Results A total of 36 patients with DAVF were enrolled,29 of them received 3D-TOF-MRA.The fistula location of 24 patients(24/36,66.7%)underwent SWI and 26 patients(26/29,89.7%)underwent 3D-TOF-MRA were correctly judged,and the difference was statistically significant(Fisher's Exact Test,P=0.039).SWI showed that the proportion of patients with thickened supply arteries(7/36,19.4%)was significantly lower than that on 3D-TOF-MRA(14/29,48.3%;χ^(2)=6.105,P=0.013).T2WI,3D-TOF-MRA and SWI showed no cerebral venous abnormalities in all 7 patients with DAVF without cortical venous reflux;in 29 patients with DAVF with cortical venous reflux revealed by DSA,SWI and T2WI showed all patients(100%)and 26 patients(89.7%)had superficial venous dilatation respectively,but there was no significant difference(χ^(2)=0.693,P=0.405).SWI showed medullary vein dilation in 17 patients(47.2%),and only 2 patients(5.6%)had medullary vein thickening on T2WI,and the difference was statistically significant(P<0.001).The proportion of patients with venous cerebral infarction on T2WI was significantly higher than that on SWI(22.2%vs.0%;Fisher’s Exact Test P=0.005),and the proportion of patients with intracerebral hemorrhage on SWI was significantly higher than that on T2WI(61.1%vs.25.0%;χ^(2)=9.574,P=0.004).Conclusion SWI is helpful to evaluate the abnormal drainage vein of DAVF and the secondary changes in brain,especially intracerebral hemorrhage.