CAJ | 학술논문

目的：探讨脑弥漫性轴索损伤(Diffuse Axonal Injury，DAI)的临床特征以及MRI、CT的诊断价值。资料与方法搜集经临床及MRI证实的47例DAI的临床及影像资料回顾性分析。所有患者均在伤后接受CT与MRI检查。MRI采用T1WI、快速自旋回波(FSE)T2WI、T2液体衰减反转恢复序列(T2-FLAIR)、弥散加权成像(DWI)。CT采用常规程序扫描。比较CT及MR各序列脑内病灶的显示率，分析其临床及影像表现特征。结果47例DAI患者经MRI均发现脑实质非出血性挫裂伤及小出血灶，T2-FLAIR和DWI序列共发现DAI病灶535个，主要分布在皮髓交界区、脑干、胼胝体、基底节、丘脑及小脑，其中T2-FLAIR显示病灶但DWI显示为阴性的病灶数共45个,而DWI显示病灶但T2-FLAIR显示为阴性的病灶数共21个。47例患者中，MRI共检出514个病灶，CT仅检出95个病灶，两者差异显著(P＜0.01)。MRI见2例合并颈椎骨质水肿及颈髓损伤水肿。结论 MRI对DAI具有较高的诊断价值，联合T2-FLAIR和DWI可以提高DAI病灶的检出率，对具有典型DAI临床特征而CT检查未发现DAI者，应尽早MRI检查，以弥补CT的局限性，对临床早期诊断以及治疗和预后具有重要价值。
목적：탐토뇌미만성축색손상(Diffuse Axonal Injury，DAI)적림상특정이급MRI、CT적진단개치。자료여방법수집경림상급MRI증실적47례DAI적림상급영상자료회고성분석。소유환자균재상후접수CT여MRI검사。MRI채용T1WI、쾌속자선회파(FSE)T2WI、T2액체쇠감반전회복서렬(T2-FLAIR)、미산가권성상(DWI)。CT채용상규정서소묘。비교CT급MR각서렬뇌내병조적현시솔，분석기림상급영상표현특정。결과47례DAI환자경MRI균발현뇌실질비출혈성좌렬상급소출혈조，T2-FLAIR화DWI서렬공발현DAI병조535개，주요분포재피수교계구、뇌간、변지체、기저절、구뇌급소뇌，기중T2-FLAIR현시병조단DWI현시위음성적병조수공45개,이DWI현시병조단T2-FLAIR현시위음성적병조수공21개。47례환자중，MRI공검출514개병조，CT부검출95개병조，량자차이현저(P＜0.01)。MRI견2례합병경추골질수종급경수손상수종。결론 MRI대DAI구유교고적진단개치，연합T2-FLAIR화DWI가이제고DAI병조적검출솔，대구유전형DAI림상특정이CT검사미발현DAI자，응진조MRI검사，이미보CT적국한성，대림상조기진단이급치료화예후구유중요개치。
Objective To assess the value of MRI and CT in diagnosis of diffuse axonal injury (DAI) and analyze its clinical feature.Materials and Methods 47 cases of DAI, which were diagnosed according to clinical manifestations and MRI findings, were collected for retrospective study. All patients had undergone MRI and CT. MRI employed T1WI, T2WI, T2-FLAIR and DWI; CT applied routine serial scanning. The detection rate of cerebral DAI lesions was compared between CT and the sequences of MRI, and its clinical and imaging features were analyzed.Results At the early stage of the disease, Total 535 lesions of non-hemorrhagic or Speckled hemorrhage were detected by combination of T2-FLAIRand DWI in all 47 cases. single or multiple focal lesions in white matter of brain, mainly located in the junctional zone of cortex and medulla, brain stem, corpus callosum, basal nodal region, interbrain and cerebellum. 45 lesions were identified by T2-FLAIR and were not detected by DWI, 21 lesions were identified by DWI and were not detected by T2-FLAIR. Of the 47 cases, MRI found out 535 lesions and CT told 95(P<0.01). 2 cases with cervical cord injury and cervical vertebra edema were proved with MRI.Conclusion MRI is of great value for the diagnosis of DAI. Combination of T2-FLAIR and DWI can improve detection ratio for diffuse axonal injury lesions. The DAI with typical clinic features, which didn't detected on CT, should be assess on MRI as early as possible. It can be considered as a supplement to CT scans and may provide useful information for early diagnosis,treatment protocol selection and prognosis.