CAJ | 학술논문

目的探讨磁共振磁敏感加权成像(susceptibility weighted imaging,SWI)和扩散加权成像(diffusion weighted imaging,DWI)对脑弥漫性轴索损伤(diffuse axonal injury,DAI)的诊断价值及其与临床病情严重程度、预后评价间的关系. 方法对49例临床诊断DAI的患者常规行T1加权成像(T1WI)、T2加权成像(T2WI)、DWI和SWI扫描,分析其各自信号特征及分布特点,比较各序列DAI病灶的检出率和检出体积差异,并与GCS、格拉斯哥预后评分(Glasgow outcome score,GOS)进行相关性分析. 结果 SWI较其他序列能更清楚、更多地显示脑内微小出血灶(P＜0.01),而DWI较其他序列能更清楚、更多检出水肿灶(P＜0.01).SWI、DWI检出病灶体积均明显高于T1WI和T2WI,前两者比较经Mann-Whitney检验差异具有统计学意义(P＜0.01).SWI检出病灶数量和体积、DWI检出病灶数量以及脑白质、皮髓交界区、小脑、脑干、胼胝体及基底节区等易损区检出病灶数与入院时GCS、检查前1 h GCS及出院后随访GOS之间呈负相关(P＜0.05),DWI上病灶体积与检查前1 h GCS及出院后随访GOS也呈负相关(P＜0.01). 结论 SWI和DWI序列能非常敏感而有效地检出外伤后DAI患者的脑内微小出血灶和水肿灶,进而为DAI的早期临床诊治及预后评估提供更多帮助.
목적 탐토자공진자민감가권성상(susceptibility weighted imaging,SWI)화확산가권성상(diffusion weighted imaging,DWI)대뇌미만성축색손상(diffuse axonal injury,DAI)적진단개치급기여림상병정엄중정도、예후평개간적관계. 방법 대49례림상진단DAI적환자상규행T1가권성상(T1WI)、T2가권성상(T2WI)、DWI화SWI소묘,분석기각자신호특정급분포특점,비교각서렬DAI병조적검출솔화검출체적차이,병여GCS、격랍사가예후평분(Glasgow outcome score,GOS)진행상관성분석. 결과 SWI교기타서렬능경청초、경다지현시뇌내미소출혈조(P＜0.01),이DWI교기타서렬능경청초、경다검출수종조(P＜0.01).SWI、DWI검출병조체적균명현고우T1WI화T2WI,전량자비교경Mann-Whitney검험차이구유통계학의의(P＜0.01).SWI검출병조수량화체적、DWI검출병조수량이급뇌백질、피수교계구、소뇌、뇌간、변지체급기저절구등역손구검출병조수여입원시GCS、검사전1 h GCS급출원후수방GOS지간정부상관(P＜0.05),DWI상병조체적여검사전1 h GCS급출원후수방GOS야정부상관(P＜0.01). 결론 SWI화DWI서렬능비상민감이유효지검출외상후DAI환자적뇌내미소출혈조화수종조,진이위DAI적조기림상진치급예후평고제공경다방조.
Objective To assess the diagnostic value of susceptibility weighted imaging (SWIl)and diffusion weighted imaging (DWI) for diffuse axonal injury (DAI) and their correlation with evaluation of injury severity and outcome.Methods Forty-nine patients with clinically diagnosed DAI underwent routine T1WI,T2WI,DWI,and SWI scanning.Respective signal characteristics and distribution features were detected.Number and volume of DAI lesions detected in each sequence were compared and analyzed for correlation with Glasgow coma score (GCS) and Glasgow outcome score (GOS).Results By contrast,SWI provided relatively better detection of intracranial micro-hemorrhage lesions (P ＜ 0.01),while DWI attained better presented edema lesions (P ＜ 0.01).Lesion volumes on SWI and DWI were significantly higher than those on TIWI and T2WI,but they were significantly different in Mann-Whitney test (P ＜ 0.01).SWI lesion number and volume,DWI lesion number as well as major lesion number at vulnerable zones of alba,cortex-medullar junction,cerebellum,brain stem,corpus callosum,and basal ganglia were negatively correlated with GCS on admission,GCS at 1 hour before examination and GOS at follow-up (P ＜ 0.05).Moreover,DWI lesion volume showed negative relation to GCS at 1 hour before examination and GOS at follow-up (P ＜ 0.01).Conclusion SWI and DWI can be pretty sensitive and effective to detect intracranial micro-hemorrhage and edema lesions in posttraumatic DAI patients and hence offer more help for early diagnosis and treatment of DAI as well as outcome evaluation.