检验医学与临床
檢驗醫學與臨床
검험의학여림상
Laboratory Medicine and Clinic
2015年
22期
3334-3336
,共3页
脑弥漫性轴索损伤%磁敏感成像%格拉斯哥昏迷评分
腦瀰漫性軸索損傷%磁敏感成像%格拉斯哥昏迷評分
뇌미만성축색손상%자민감성상%격랍사가혼미평분
diffuse axonal injury%susceptibility weighted imaging%Glasgow coma scale
目的：评价磁敏感加权成像（SWI）对弥漫性轴索损伤（DAI）诊断及其与格拉斯哥昏迷（GCS）评分相关性分析的临床应用价值。方法对经临床诊断为DAI并行MRI检查的24例患者，行常规MRI（T1WI、T2WI、FLAIR、DWI）及SWI扫描，比较DAI病灶的显示率并分析其信号特征，评价SWI在DAI诊断中的价值及其与GCS评分的关系。结果24例D A I病灶主要分布在皮髓质交界区、脑白质区、基底节区、胼胝体、脑干及小脑。常规序列检出DAI病灶37个，T1WI、T2WI序列病灶呈点状或小结节状，信号表现多样。SWI序列检出DAI病灶179个，病灶呈斑点状、串珠状或线条状明显高、低或高低混杂信号。18例未累及脑中线结构，6例累及脑中线结构。24例中GCS评分轻度（13～15分）13例，中度（9～12分）6例，重度（3～8分）5例；治愈9例，好转9例，植物状态4例，死亡2例。结论 DAI病灶数目多、分布广泛或累及脑中线结构者，GCS评分低，二者均有明显相关性。SWI对DAI病灶的检出具有较高的敏感性，能较常规M RI序列检出更多的脑内微小出血灶，为临床早期诊断和治疗方案的制订及评估预后提供重要依据。
目的：評價磁敏感加權成像（SWI）對瀰漫性軸索損傷（DAI）診斷及其與格拉斯哥昏迷（GCS）評分相關性分析的臨床應用價值。方法對經臨床診斷為DAI併行MRI檢查的24例患者，行常規MRI（T1WI、T2WI、FLAIR、DWI）及SWI掃描，比較DAI病竈的顯示率併分析其信號特徵，評價SWI在DAI診斷中的價值及其與GCS評分的關繫。結果24例D A I病竈主要分佈在皮髓質交界區、腦白質區、基底節區、胼胝體、腦榦及小腦。常規序列檢齣DAI病竈37箇，T1WI、T2WI序列病竈呈點狀或小結節狀，信號錶現多樣。SWI序列檢齣DAI病竈179箇，病竈呈斑點狀、串珠狀或線條狀明顯高、低或高低混雜信號。18例未纍及腦中線結構，6例纍及腦中線結構。24例中GCS評分輕度（13～15分）13例，中度（9～12分）6例，重度（3～8分）5例；治愈9例，好轉9例，植物狀態4例，死亡2例。結論 DAI病竈數目多、分佈廣汎或纍及腦中線結構者，GCS評分低，二者均有明顯相關性。SWI對DAI病竈的檢齣具有較高的敏感性，能較常規M RI序列檢齣更多的腦內微小齣血竈，為臨床早期診斷和治療方案的製訂及評估預後提供重要依據。
목적：평개자민감가권성상（SWI）대미만성축색손상（DAI）진단급기여격랍사가혼미（GCS）평분상관성분석적림상응용개치。방법대경림상진단위DAI병행MRI검사적24례환자，행상규MRI（T1WI、T2WI、FLAIR、DWI）급SWI소묘，비교DAI병조적현시솔병분석기신호특정，평개SWI재DAI진단중적개치급기여GCS평분적관계。결과24례D A I병조주요분포재피수질교계구、뇌백질구、기저절구、변지체、뇌간급소뇌。상규서렬검출DAI병조37개，T1WI、T2WI서렬병조정점상혹소결절상，신호표현다양。SWI서렬검출DAI병조179개，병조정반점상、천주상혹선조상명현고、저혹고저혼잡신호。18례미루급뇌중선결구，6례루급뇌중선결구。24례중GCS평분경도（13～15분）13례，중도（9～12분）6례，중도（3～8분）5례；치유9례，호전9례，식물상태4례，사망2례。결론 DAI병조수목다、분포엄범혹루급뇌중선결구자，GCS평분저，이자균유명현상관성。SWI대DAI병조적검출구유교고적민감성，능교상규M RI서렬검출경다적뇌내미소출혈조，위림상조기진단화치료방안적제정급평고예후제공중요의거。
Objective To evaluate the clinical application value of susceptibility weighted imaging(SWI) in di‐agnosis of diffuse axonal injury(DAI) and to investigate its correlation with Glasgow coma score(GCS) .Methods 24 patients with clinically diagnosed DAI were performed the conventional MRI including T1WI ,T2WI ,FLAIR ,DWI and SWI scanning .The demonstration rate of DAI lesions was compared and its signal characteristics were analyzed . The value of SWI in the diagnosis and the GCS score was evaluated .Results The DAI lesions in this group were lo‐cated in the corticomedullary junction area ,white matter area ,basal ganglia area ,corpus callosum ,brain stem and cer‐ebellum .37 DAI lesions were detected by the conventional MR sequence scanning ,T1WI and T2WI sequence lesions showed dot‐like or nodule‐like with various signal manifestations ,while 179 DAI lesions were detected by SWI se‐quence ,which showed spot‐like ,bead‐like or line‐like with apparent high ,low or high‐low mixed signals .18 cases did not involved the brain central line structure and 6 cases were involved the brain central line structure .Among 24 ca‐ses ,13 cases were mild GCS scores(13-15) ,6 cases were moderate GCS scores(9-12) and 5 cases were severe GCS scores(3-8);9 cases were cured ,9 cases were improved ,4 cases showed a state of plant and 2 cases died .Conclusion The DAI patients with many lesions ,wider distribution or involving brain central line structure got lower GCS score ,there is obvious correlation between them .SWI has higher sensitivity for detecting DAI lesion and can detect more intracerebral micro bleeding lesions than the conventional MRI sequence ,which can provide the important basis for clinically early diagnosis ,formulating the treatment scheme and evaluating the prognosis .
