中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2011年
5期
426-431
,共6页
苗延巍%蔡兆诚%张清%伍建林%胡伽尼
苗延巍%蔡兆誠%張清%伍建林%鬍伽尼
묘연외%채조성%장청%오건림%호가니
多发性硬化%磁敏感加权成像
多髮性硬化%磁敏感加權成像
다발성경화%자민감가권성상
Multiple sclerosis%Susceptibility weighted imaging
目的 探讨多发性硬化(MS)脱髓鞘斑块的磁敏感加权成像(SWI)特征表现、MS斑块形态及微循环的演变过程.方法 对31例临床确诊的MS患者进行MR检查,扫描序列包括T2WI、液体衰减反转恢复(FLAIR)序列T2WI、T1WI及SWI.其巾21例进行了MRI随访,间隔时间为2.0～20.0个月,并且15例随访患者在第2次MR检查时行动态磁敏感增强灌注成像DSC-PI).观察MS斑块在"滤过"后相位图(FPI)的特征,测量斑块相位值和灌注参数.包括脑血流量(CBF)和脑血容量(CBV),并动态分析其演变规律.不同序列检测出的斑块个数采用配对t检验进行对照分析;采用Pearson相关分析法评价斑块相位值与灌注参数的相关性.结果 在FPI上,全部患者298个MS斑块呈3种表现:(1)低信号灶,无小血管穿行(109个,37%);(2)低信号灶,有小血管穿行(169个,57%);(3)病灶区仪有"异常血管区"而无明显信号降低(20个,7%).21例随诊病例中,前后2次检查经FLAIR T2WI检出的斑块总数及均数分别为452(22±8)、439(21±7)个,T1WI检出的斑块数分别为205(10±3)、206(10±-3)个,SWI检出的斑块数分别为211(10±3)、219(10±3)个,FLAIR T2WI检出的病灶均数减少(t=2.28,P=0.03),FPI检出的病灶均数增加(t=-2.61,P=0.02),而T1WI检出的病灶均数无明显变化(t=-1.00,P=0.33).21例随访患者中,6例发现有9个脱髓鞘斑块从仪表现为异常血管区演变到出现明确的低信号灶,其相位值变化(-0.031±0.012)与CBF值的变化[(-13.92±7.99)ml·100 g-1·min-1]以及CBV值的变化[(-2.54±1.33)ml·100 g-1]具有负相关(r值分别为-0.73、-0.84,P值均<0.05).结论 SWI相位图上低信号伴有小静脉穿行是MS脱髓鞘斑块的特征性表现;联合运用SWI和DSC-PI有助于进一步理解MS斑块的病理生理演变机制,并监测病情演变.
目的 探討多髮性硬化(MS)脫髓鞘斑塊的磁敏感加權成像(SWI)特徵錶現、MS斑塊形態及微循環的縯變過程.方法 對31例臨床確診的MS患者進行MR檢查,掃描序列包括T2WI、液體衰減反轉恢複(FLAIR)序列T2WI、T1WI及SWI.其巾21例進行瞭MRI隨訪,間隔時間為2.0～20.0箇月,併且15例隨訪患者在第2次MR檢查時行動態磁敏感增彊灌註成像DSC-PI).觀察MS斑塊在"濾過"後相位圖(FPI)的特徵,測量斑塊相位值和灌註參數.包括腦血流量(CBF)和腦血容量(CBV),併動態分析其縯變規律.不同序列檢測齣的斑塊箇數採用配對t檢驗進行對照分析;採用Pearson相關分析法評價斑塊相位值與灌註參數的相關性.結果 在FPI上,全部患者298箇MS斑塊呈3種錶現:(1)低信號竈,無小血管穿行(109箇,37%);(2)低信號竈,有小血管穿行(169箇,57%);(3)病竈區儀有"異常血管區"而無明顯信號降低(20箇,7%).21例隨診病例中,前後2次檢查經FLAIR T2WI檢齣的斑塊總數及均數分彆為452(22±8)、439(21±7)箇,T1WI檢齣的斑塊數分彆為205(10±3)、206(10±-3)箇,SWI檢齣的斑塊數分彆為211(10±3)、219(10±3)箇,FLAIR T2WI檢齣的病竈均數減少(t=2.28,P=0.03),FPI檢齣的病竈均數增加(t=-2.61,P=0.02),而T1WI檢齣的病竈均數無明顯變化(t=-1.00,P=0.33).21例隨訪患者中,6例髮現有9箇脫髓鞘斑塊從儀錶現為異常血管區縯變到齣現明確的低信號竈,其相位值變化(-0.031±0.012)與CBF值的變化[(-13.92±7.99)ml·100 g-1·min-1]以及CBV值的變化[(-2.54±1.33)ml·100 g-1]具有負相關(r值分彆為-0.73、-0.84,P值均<0.05).結論 SWI相位圖上低信號伴有小靜脈穿行是MS脫髓鞘斑塊的特徵性錶現;聯閤運用SWI和DSC-PI有助于進一步理解MS斑塊的病理生理縯變機製,併鑑測病情縯變.
목적 탐토다발성경화(MS)탈수초반괴적자민감가권성상(SWI)특정표현、MS반괴형태급미순배적연변과정.방법 대31례림상학진적MS환자진행MR검사,소묘서렬포괄T2WI、액체쇠감반전회복(FLAIR)서렬T2WI、T1WI급SWI.기건21례진행료MRI수방,간격시간위2.0～20.0개월,병차15례수방환자재제2차MR검사시행동태자민감증강관주성상DSC-PI).관찰MS반괴재"려과"후상위도(FPI)적특정,측량반괴상위치화관주삼수.포괄뇌혈류량(CBF)화뇌혈용량(CBV),병동태분석기연변규률.불동서렬검측출적반괴개수채용배대t검험진행대조분석;채용Pearson상관분석법평개반괴상위치여관주삼수적상관성.결과 재FPI상,전부환자298개MS반괴정3충표현:(1)저신호조,무소혈관천행(109개,37%);(2)저신호조,유소혈관천행(169개,57%);(3)병조구의유"이상혈관구"이무명현신호강저(20개,7%).21례수진병례중,전후2차검사경FLAIR T2WI검출적반괴총수급균수분별위452(22±8)、439(21±7)개,T1WI검출적반괴수분별위205(10±3)、206(10±-3)개,SWI검출적반괴수분별위211(10±3)、219(10±3)개,FLAIR T2WI검출적병조균수감소(t=2.28,P=0.03),FPI검출적병조균수증가(t=-2.61,P=0.02),이T1WI검출적병조균수무명현변화(t=-1.00,P=0.33).21례수방환자중,6례발현유9개탈수초반괴종의표현위이상혈관구연변도출현명학적저신호조,기상위치변화(-0.031±0.012)여CBF치적변화[(-13.92±7.99)ml·100 g-1·min-1]이급CBV치적변화[(-2.54±1.33)ml·100 g-1]구유부상관(r치분별위-0.73、-0.84,P치균<0.05).결론 SWI상위도상저신호반유소정맥천행시MS탈수초반괴적특정성표현;연합운용SWI화DSC-PI유조우진일보리해MS반괴적병리생리연변궤제,병감측병정연변.
Objective To identify the imaging characteristics of demyelinating plaques in multiple sclerosis (MS) by using susceptibility weighted imaging(SWI),and further explore their morphologic and inicro-hemodynamic evolvements.Methods Thirty-one cases with clinically proven MS received SWI and dynamical susceptibility contrasted MR perfusion imaging(DSC-PI).And 21 cases received MR again in the fbllow-up period,with a time interval of 2.0-20.0 months[mean(7.5±4.8)months].Features of MS plaques in filtered phase images(FPI)were assessed,and the number of MS plaques detected in T1 WI,T2 FLAIR and FPI images were counted respectively.The measurements of phase values and perfusion parameters(including CBF and CBV)were acquired and their variation over time was also evaluated.The number of plaques detected by different MR sequences was compared by using paired t test,and the correlation between phase values and perfusion parameters was evaluated by using Pearson correlative analysis.Results Three types of MS plaques were observed in FPI images,including(1) round or oval hypointense foci without small veins(109 of 298,37%),(2)hypointense foci with small veins(169 of 298, 57% ), (3) abnormal vessels alone without hypointense foci (20 of 298, 7% ). In the 21 cases received MR follow-up, the total and mean plaque numbers identified on T2 FLAIR images were 452 and (22±8) in the first MR examination, and 439 and (21±7)in the second MR examination; and on T1-weithed images, they were 211 and( 10±3 ) in the first MR examination, and 219 and( 10±3 ) in the second MR examination; as well as those on FPI images were 205 and ( 10±3), and 206 and(10±3),respectively. Compared between the first and second MR scan, the mean of number on T2 FLAIR images decreased (t= 2. 28, P= 0. 03 ), and that on FPI images increased( t = -2. 61, P = 0. 02 ), and then that onT1-weight images keep invariable ( t = - 1. 00, P = 0. 33 ). Moreover, a development from regions with "abnormal vessels" alone to hypointense foci were observed in 9 plaques from 6 folh,w-up cases. The changes of phase values of these 9 plaques were significant correlated with CBF' and CBV (r = -0. 73 ,P <0. 05 ;r = -0. 84, P < 0. 05 ). Conclusions Hypointense focus with or without small veins on FPI image is the characteristic manifestation of MS plaques. Combination of SWI and DSC-PI is helpful in further understanding the patho-physiological mechanism of MS plaques and monitoring the evolvement of them.
