CT与MR检查对弥漫性轴索损伤诊断价值的研究

发布时间：2018-08-24 10:58

【摘要】：目的:研究对比CT和MRI常规序列(T1WI、T2WI、FLAIR)及特殊序列(DWI、SWI)对弥漫性轴索损伤(DAI)病灶的检出数间有无差异,各种影像手段对弥漫性轴索损伤的出血性病灶和非出血性病灶的检出率间有无差异,从中得到更具有临床价值的诊断方法,提高临床对弥漫性轴索损伤病灶检出及疾病的认识。方法:收集延安大学附属医院东关分院神经外科2013年3月至2015年1月临床诊断为弥漫性轴索损伤的患者临床资料和影像学资料。以入选标准和排除标准,总共筛选出37例患者资料进行影像学分析。本组37例临床诊断为DAI患者均于伤后72小时内于我院影像科行颅脑CT检查,以初次CT结果为准。37例患者根据病情稳定与否,尽可能在入院后一周内进行MRI检查,必要时可延迟至患者生命体征稳定情况下进行MRI检查;MRI检查序列包括T1WI、T2WI、FLAIR、DWI、SWI序列。对于烦躁患者给予一定剂量镇静剂,避免对检查结果受到影响。CT和MRI影像学资料均是从我院CT室获取,同时由神经科高年资主治医师与一名有经验的放射科医师以双盲法阅片获取DAI患者的病灶数。结果:37例DAI患者行上述影像学检查,对于脑干部位,CT漏诊数相对其他位置较少,对小脑部位的病灶检出漏诊数较高。MRI常规序列中,FLAIR检测病灶最多,与T1WI、T2WI病灶检出数之间差异有统计学意义(χ2=22.930,P=0.011㩳0.05)。发现特殊序列中,SWI病灶检出数最多,DWI与SWI检出数间差异有统计学意义(χ2=13.090,P=0.02㩳0.05)。将CT、FLAIR、SWI检出数进行比较,SWI检出数最多,差异有统计学意义(χ2=19.634,P=0.033㩳0.05)。DWI对非出血病灶最敏感,其次为FLAIR(χ2=188.168,P0.001)。SWI对出血病灶检出率最高,其次为DWI(χ2=1363.452,P㩳0.001)。结论:对于DAI患者病灶总数检出数最多的是SWI序列。对于出血性病灶检出率SWI具有明显优势,在非出血性病灶,DWI检出率明显高于其他序列相比。因此可以说DWI与SWI序列对DAI的明确诊断提供重要的影像依据,具有很高的应用价值。
[Abstract]:Objective: to study the difference between CT and MRI routine sequence (T1WIT2WIFLAIR) and special sequence (DWI,SWI) in detecting (DAI) lesions with diffuse axonal injury. There is no difference in the detection rate between hemorrhagic and non-hemorrhagic lesions of diffuse axonal injury by various imaging methods, from which a more valuable diagnostic method is obtained to improve the clinical understanding of the detection and disease of diffuse axonal injury. Methods: the clinical data and imaging data of the patients diagnosed as diffuse axonal injury from March 2013 to January 2015 in the Department of Neurosurgery, Dongguan Branch, affiliated Hospital of Yan'an University were collected. According to the inclusion criteria and exclusion criteria, a total of 37 patients were selected for imaging analysis. All 37 cases of clinically diagnosed DAI underwent craniocerebral CT examination in our hospital imaging department within 72 hours after injury. According to the results of initial CT, 37 cases underwent MRI examination as far as possible within one week after admission according to their stable condition. If necessary, the MRI sequence can be delayed until the patient's vital signs are stable, including T _ 1WI _ I _ T _ 2W _ I _ FLAIRI / DWI _ I sequence. Patients with irritability were given a certain dose of tranquilizer to avoid the influence of the results of the examination. Ct and MRI imaging data were obtained from the CT room of our hospital. At the same time, the number of lesions in patients with DAI was obtained by a senior attending physician in neurology and an experienced radiologist. Results in 37 cases of DAI, the number of missed CT diagnosis in brain stem was less than that in other locations, and the number of missed diagnosis in cerebellar lesions was higher. Flair was the most frequently detected lesions in routine sequence. There was significant difference between the number of lesions detected on T _ 1WI and T _ 1WI (蠂 ~ 2 = 22.930) (蠂 ~ 2 = 22.930). It was found that there was a significant difference between SWI and DWI in detecting the most lesions in special sequences (蠂 ~ 2: 13.090) (蠂 ~ 2: 13.090). CT,FLAIR,SWI was the most sensitive to non-bleeding lesions, followed by FLAIR (蠂 2188.168 P0.001), followed by DWI (蠂 21363.452P0. 001). Conclusion: SWI sequence is the most detectable number of lesions in patients with DAI. The detection rate of SWI in non hemorrhagic lesions was significantly higher than that in other sequences. Therefore, it can be said that DWI and SWI sequences provide an important imaging basis for the definite diagnosis of DAI, and have high application value.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.15

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