SWI 测量脑铁在帕金森病病情评估中的应用价值

目的：探讨磁敏感加权成像(SWI)测量脑铁在帕金森病(PD)的诊断以及病情评估中的应用价值。方法30例经临床诊断为PD 的患者行颅脑磁共振常规序列和 SWI 序列扫描,PD 患者病情评估采用统一帕金森病评定量表(UPDRS)。在 SWI 序列相位图上手动测量患者黑质、红核、尾状核、苍白球和壳核的相位值,分析以上感兴趣区(ROI)核团的相位值与 UPDRS 评分的相关性。结果ROI 核团病重侧与病轻侧的相位值比较无差异(黑质,P =0.120;红核,P =0.402;尾状核,P =0.196;苍白球,P =0.616;壳核, P =0.985);PD 患者 UPDRS Ⅲ评分分别与黑质、尾状核和苍白球的相位值呈负相关(黑质-UPDRS Ⅲ：r =-0.407,P =0.026;尾状核-UPDRS Ⅲ：r=-0.424,P=0.02;苍白球-UPDRS Ⅲ：r=-0.363,P=0.048);黑质相位值与 UPDRS Ⅴ的分期呈负相关(r=-0.373, P =0.043);尾状核相位值与 UPDRSⅠ的评分呈负相关(r=-0.367,P =0.046);苍白球相位值与 UPDRS Ⅲ中的步态障碍评分呈负相关(r=-0.411,P =0.024),而其余核团的相位值与 UPDRS 评分不相关。结论SWI 可以定量评估 PD 患者脑部核团的异常铁沉积,为 PD 的临床诊断和病情评估提供参考。     

磁共振T2*评价长期输血患者肝脏铁过载的价值

目的 探讨磁共振T2*在评估长期输血患者肝脏铁过载的价值.方法 搜集2011年12月至2012年6月长期输血患者28例,输血史12～ 69个月不等.应用Siemens Magnetom Trio 3.0 T磁共振设备的梯度回波序列对全部患者肝脏进行扫描并应用CMR tool软件(2010版)计算出肝脏感兴趣区域的T2*值;同时抽取患者静脉血,用紫外分光光度法检测血清铁蛋白水平.结果 28例患者的T2*值范围为0.9～17.8 ms,均数±标准差为(3.63±4.84) ms;血清铁蛋白浓度范围为118～7855 ng/ml,均数±标准差为(2098.60±1578.68) ng/ml.应用SPSS 16.0统计软件对T2*与血清铁蛋白进行相关性分析,两者呈负相关(P =0.015),相关系数为-0.535.结论 磁共振T2*在评估长期输血患者肝脏铁过载方面有一定价值.     

磁敏感加权成像定量测量在鉴别诊断帕金森病和血管性帕金森综合征中的应用

目的 探讨在磁敏感加权成像(SWI)上测量脑内锥体外系各核团相位值对帕金森病(PD)和血管性帕金森综合征(VPS)的诊断及鉴别诊断价值.资料与方法 在SWI上对20例PD患者(PD组)、20例VPS患者(VPS组)和20例正常对照者(对照组)脑内锥体外系各核团进行相位值测量,并进行比较.结果 PD组较VPS组及对照组黑质致密带(SNc)、苍白球(GP)、壳核(PUT)相位值均明显降低(P＜0.01);VPS患者与对照组比较,差异无统计学意义(P＞0.05).PD组SNc、GP及PUT相位值在早期即已经降低,随病情加重其相位值进一步降低(P＜0.01);中晚期其黑质网状带(SNr)相位值降低(P＜0.05).VPS组在早中期各感兴趣区相位值均无明显变化,仅在晚期SNc、PUT、尾状核(CN)及SNr、GP相位值轻度降低(SNc、PUT、CN:P＜0.01;SNr、GP:P＜0.05).双侧红核(RN)比较,差异均无统计学意义(P＞0.05).结论 应用SWI测量脑内锥体外系各核团相位值对PD和VPS的评估具有临床诊断价值.     

磁敏感加权成像Phase图在脑梗死演变诊断中的临床应用价值

目的 探讨磁敏感加权成像(susceptibility-weighted imaging, SWI)Phase图在各期脑梗死的变化规律及其临床应用价值.方法 对65例脑梗死各期患者进行SWI及随诊检查,超急性期(<6 h)9例,急性期(7～24 h)20例,亚急性期(1.5～7 d)21例,稳定期(8～14 d)5例,慢性期(>15 d)10例.观察各期脑梗死SWI Phase图上的表现,分别测量最大层面梗死灶受累白质区及对侧相应部位的Phase均值;另外,选取健康志愿者65例进行SWI检查,测量大脑白质区的Phase均值,并进行统计学分析.结果 (1)超急性期及急性期脑的梗死组织的相位值均较对侧健康志愿者脑白质区(HVWM)明显增高,进入亚急性期,相位值较对侧略低,在稳定期和慢性期较对侧明显降低.各期患侧与健侧相位平均值行配对Wilcoxon秩和检验,在超急性期、急性期、稳定期和慢性期两者有显著差别(P<0.001),亚急性期,稍有差异(P=0.04);(2)脑梗死各期病变区平均相位值随着发病时间的延长,逐渐下降,到慢性期最低,梗死区的相位值与发病时间具有显著负相关性(r=-0.990,P=0.001).结论 利用SWI Phase图可对脑梗死的分期进行评估诊断.     

弥漫性轴索损伤磁敏感加权成像的实验研究

目的:用磁敏感加权成像(SWI)观察大鼠弥漫性轴索损伤(DAI)后的变化规律。方法:采用液压颅脑损伤模型制备32只DAI的SD大鼠模型,并于模型制作前、DAI后6h和24h分别进行常规磁共振成像和SWI成像(GE 3.0T超导磁共振成像仪)。比较各序列图像上DAI病灶检出数,在各时间点SWI图像上测量双侧皮髓质交界处感兴趣区(ROI)的相位弧度值,并分析其变化规律。结果:SWI对DAI病灶的检出率显著高于常规的MRI序列(P<0.05)。伤后6h,骨窗侧出血灶相位弧度值较致伤前变为负值;对侧相位值升高,差异有统计学意义(P<0.05),伤后24h,DAI鼠出血灶部位的相位弧度值较伤后6h相位弧度值变化差异无统计学意义(P>0.05);结论:磁敏感加权成像(SWI)检出弥漫性轴索损伤病灶的敏感性高于常规MRI序列,相位弧度值的变化反映了DAI的宏观变化过程,其变化规律与顺磁性物质有关。     

3.0T MR扩散加权成像ADC阈值诊断肝硬化严重程度的研究

目的利用3.0 T MR扩散加权成像(DWI)测量肝硬化患者及健康自愿者肝脏表观扩散系数(ADC)值,探讨ADC阈值在诊断肝硬化严重程度中的价值。资料与方法 (1)肝硬化组:肝硬化患者53例,男35例,女18例,年龄30～76岁,平均(55.02±12.56)岁,Child-Pugh A、B、C级患者分别为18例、25例和10例。(2)对照组:健康自愿者30名,其中男18名,女12名,年龄30～79岁,平均(52.34±12.68)岁。两组均采用3.0T磁共振扫描仪行DWI,分别测量3组b值(500、800和1000s/mm2)下肝脏的ADC值。结果 b=500和1000s/mm2时诊断肝硬化的敏感性和特异性均较b=800s/mm2高;同时b=500s/mm2诊断肝硬化的敏感性和特异性又较b=1000s/mm2高。结论 MR-DWI ADC阈值在评价肝硬化严重程度上具有很高的敏感性和特异性。     

Hepatic function and hemodynamics in cirrhosis:a 3.0T dynamic contrast-enhanced MRI study

目的:探讨3.0T磁共振增强技术在对比研究正常肝脏及肝硬化肝脏血流变化与肝功能的相关性中的应用价值.方法:分别对53例肝硬化患者(肝硬化组)及46例健康人(正常对照组)进行MR对比剂动态增强扫描,连续扫描10期.分别测量肝、脾、门静脉及腹主动脉的最大上升斜率(MSI)、信号增强率(SER)、正性增强积分(PEI)、最大下降斜率(MSD)和峰值(PV).比较肝硬化组与正常对照组血流参数,同时分析以上测量指标与肝硬化、Child-Pugh分级以及临床肝功能血清标记物之间的关系.结果:在肝硬化组,肝脏的PEI及PV,门静脉的PV,以及腹主动脉的MSI、PEI及PV均小于正常对照组(P值均<0.05).在肝硬化组,肝脏的MSI、SER、PEI、MSD及PV,门静脉的PEI及PV,腹主动脉的MSD均随着Child-Pugh分级的增加而下降,差异具有统计学意义(P值均<0.05).但脾脏的MSI、SER、PEI、MSD及PV在肝硬化组与正常对照组之间、不同Child-Pugh分级之间差异均无统计学意叉(P值均>0.05).另外,肝硬化组MSI、MSD和PV均分别与TBIL,总胆红素和IBIL,间接胆红素呈负相关(P值均<0.05),PEI与IBIL呈负相关(P=0.019,r=0.486),其余动态参数与肝功能血清标记物未见相关性(P>0.05).结论:MR时比剂动态增强技术可无创评估肝硬化血流动力学的变化,在肝功能的评估方面也具有一定的价值.     

脑多发性硬化的磁敏感加权成像诊断及鉴别诊断价值

目的比较多发性硬化(multiple sclerosis,MS)、脑梗死患者及正常对照组感兴趣区的相位值,探讨其诊断MS的价值。方法 12例MS和20例脑梗死患者均经临床病史和(或)实验室检查证实,对照组选择年龄相匹配的健康志愿者各30例。所有参与者均接受常规MR检查和SWI。结果正常志愿者感兴趣区的相位值均无显著的性别、侧别差异,其与年龄亦无显著相关,双侧额叶白质相位值低于其他感兴趣区,但无明显统计学差异;与年龄相匹配的正常志愿者组比较,MS组双侧额叶、顶叶、枕叶白质、脑干及小脑白质无病灶区相位值均低于对照组,但只有额叶和枕叶的相位值与对照组比较有明显差异(P<0.05);脑梗死组无病灶区相位值均低于年龄相匹配正常志愿者,但无明显统计学差异;MS组及脑梗死组比较,两组间上述感兴趣区相位值比较亦无明显统计学差异;与脑梗死组比较,MS组病灶区相位值明显降低,配对t检验分析,两组间相位值比较具有统计学差异(P<0.05),此外,12例MS组227个病灶中126个病灶周围伴行静脉,49个病灶内可见静脉穿行,病灶周边为低信号环者56个,20例脑梗死患者病灶区及周围未见明显类似表现。结论 SWI有助于提高对活体多发性硬化和脑梗死病灶病理特征的认识,可以作为二者鉴别诊断的定量补充,在一定程度上指导临床选择治疗方案。     

磁敏感加权成像在中枢神经系统肿瘤中的应用

目的 探讨磁敏感加权成像(susceptibility weighted imaging,SWI)在脑肿瘤诊断中的应用价值.资料与方法 回顾性分析在手术病理证实前均行T1液体衰减反转恢复序列(FLAIR)、T2FLAIR、SWI及增强T1 FLAIR检查的51例脑肿瘤患者资料.计算病灶与正常对照区的校正相位值(CP),并对SWI与增强T1FLAIR显示的肿瘤静脉、出血产物进行统计学比较.结果 SWI对于肿瘤内的出血及小静脉显示敏感,病灶与正常对照区的CP值分别为-0.288±0.332及0.050±0.155,差异有统计学意义(t=-3.489,P＜0.05).SWI比增强T1FLAIR能更清楚地显示肿瘤结构的细节.结论 SWI对肿瘤的边界、内部结构、出血和静脉血管及水肿区的显示有很高的临床应用价值,对肿瘤的准确分级可能有用.     

DCE-MRI在评估肝硬化血流动力学与肝功能关系中的应用

目的:探讨3.0T磁共振增强技术在对比研究正常肝脏及肝硬化肝脏血流变化与肝功能的相关性中的应用价值。方法:分别对53例肝硬化患者(肝硬化组)及46例健康人(正常对照组)进行MR对比剂动态增强扫描,连续扫描10期。分别测量肝、脾、门静脉及腹主动脉的最大上升斜率(MSI)、信号增强率(SER)、正性增强积分(PEI)、最大下降斜率(MSD)和峰值(PV)。比较肝硬化组与正常对照组血流参数,同时分析以上测量指标与肝硬化、Child-Pugh分级以及临床肝功能血清标记物之间的关系。结果:在肝硬化组,肝脏的PEI及PV,门静脉的PV,以及腹主动脉的MSI、PEI及PV均小于正常对照组(P值均<0.05)。在肝硬化组,肝脏的MSI、SER、PEI、MSD及PV,门静脉的PEI及PV,腹主动脉的MSD均随着Child-Pugh分级的增加而下降,差异具有统计学意义(P值均<0.05)。但脾脏的MSI、SER、PEI、MSD及PV在肝硬化组与正常对照组之间、不同Child-Pugh分级之间差异均无统计学意义(P值均>0.05)。另外,肝硬化组MSI、MSD和PV均分别与TBIL总胆红素和IBIL间接胆红素呈负相关(P值均<0.05),PEI与IBIL呈负相关(P=0.019,r=0.486),其余动态参数与肝功能血清标记物未见相关性(P>0.05)。结论:MR对比剂动态增强技术可无创评估肝硬化血流动力学的变化,在肝功能的评估方面也具有一定的价值。     

定量磁化率图对脑微出血铁含量动态变化的随访研究

目的 应用定量磁化率图（QSM）随访研究脑内微出血（CMB）病灶体积变化与磁敏感值变化之间的相关性,探讨CMB铁含量的动态变化。 方法 回顾性收集行头颅常规MRI序列及磁敏感加权成像（SWI）序列检查中具有明确CMB的病人资料,所有病人均进行了基线和随访检查（2次检查时间间隔约12个月）。共纳入病人35例,男27例,女8例,平均（67.94±9.57）岁。将SWI序列原始相位图和幅度图进行后处理得到QSM,在基线和随访QSM上手动勾画CMB的兴趣区（ROI）,选取ROI内磁敏感值≥130ppb的CMB病灶,测量ROI内像素数作为CMB体积;同时在ROI上测量并记录CMB最大磁敏感值、平均磁敏感值。根据随访与基线CMB体积变化,将CMB病灶分为体积增大、体积减小及体积不变组。采用Spearman相关分析CMB体积与最大磁敏感值、平均磁敏感值的相关性。采用配对样本t检验比较不同组内基线及随访CMB的磁敏感值变化。 结果 共纳入CMB 病灶322个,其基线QSM上所示病灶体积、最大磁敏感值、平均磁敏感值均高于随访QSM所见（均P<0.05）。基线及随访的CMB体积与最大磁敏感值、平均磁敏感值均呈正相关（均P<0.05）。根据随访与基线CMB体积变化,将病灶分为增大组108个、减小组198个、不变组16个。体积增大组随访水平的最大磁敏感值、平均磁敏感值均高于基线水平（均P<0.05）;体积减小组随访水平最大磁敏感值、平均磁敏感值均低于基线水平（均P<0.05）;体积不变组随访水平和基线水平的差异无统计学意义（均P>0.05）。 结论 随着时间的推移,CMB病灶体积、磁敏感值会发生变化。CMB磁敏感值的变化受体积变化的影响,间接反映CMB铁含量的动态变化。     

Serum ferritin as a marker of potential biochemical iron overload in athletes.

OBJECTIVES: Beyond hematological manipulation, iron supplementation therapy is commonplace in athletes to counterbalance physiological or pathologic anemia and to prevent physiologic dysfunction. However, misuse of iron therapy, occasionally resulting in iron overload, is not free from metabolic risks. DESIGN: We planned to measure baseline serum ferritin concentration in sedentary individual and athletes. SETTING: The Institute of Clinical Biochemistry of the Verona University. PARTICIPANTS Serum ferritin was measured in 60 male healthy sedentary controls, 80 amateur road cyclists, 42 male professional cross-country skiers, and 88 professional male road cyclists. ASSESSMENT OF RISK FACTORS: The biochemical iron overload was ascertained by measuring baseline serum ferritin concentration as a reliable approach that mirrors the total body iron content. MAIN OUTCOME MEASUREMENTS: The concentration of serum ferritin in healthy controls was 112 +/- 78 ng/mL, whereas that of amateur cyclists, professional skiers, and professional cyclists was 127 +/- 76 ng/mL (P = 0.185), 183 +/- 130 ng/mL (P = 0.001), and 332 +/- 218 ng/mL (P < 0.001), respectively. RESULTS: Both categories of professional athletes showed significantly increased concentrations of serum ferritin, whereas the concentration of amateur cyclists was comparable to that of healthy sedentary controls. CONCLUSIONS: Professional endurance athletes have serum ferritin concentrations that are 2-fold to 3-fold higher than those of matched sedentary individuals and amateur athletes, exceeding the threshold for the diagnosis of biochemical iron overload and unveiling potential metabolic risks.     

Clinical usefulness of scintigraphy with 99mTc-galactosyl-human serum albumin for prognosis of cirrhosis of the liver.

Scintigraphy with 99mTc-diethylenetriamine pentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) is useful for evaluating hepatic functional reserve. We assessed the clinical usefulness of this technique, including its value in establishing a prognosis, in patients with cirrhosis of the liver. METHODS: Scintigraphy with 99mTc-GSA was performed in 10 healthy subjects, 42 patients with chronic hepatitis and 158 patients with cirrhosis. Computer acquisition of gamma camera data were started just before the injection of 99mTc-GSA. Time-activity curves for the heart and liver were generated from regions of interest (ROIs) for the heart and the entire liver. A receptor index was calculated by dividing the radioactivity of the liver ROI by that of the liver-plus-heart ROI 15 min after the injection. An index of blood clearance was calculated by dividing the radioactivity of the heart ROI at 15 min by that of the heart ROI at 3 min. RESULTS: The median receptor index was lower in patients with cirrhosis than in patients with chronic hepatitis or in healthy subjects, and the median index of blood clearance was higher. The receptor index was significantly lower when a complication (varices, ascites) was present. The index of blood clearance was significantly higher when a complication (varices and ascites) was present. Correlation of the two indices with classic indicators for functional reserve was significant. On the basis of the receptor index, the patients with cirrhosis were divided into two groups of roughly equal size: group A, receptor index over 0.85, and group B, receptor index 0.85 or less. On the basis of the index of blood clearance, the patients with cirrhosis were divided into two groups of roughly equal size: group A, index of blood clearance < 0.70, and group B, index of blood clearance > or = 0.70. The cumulative survival rates were lower in group B than in group A. CONCLUSION: Scintigraphy with 99mTc-GSA is clinically useful, especially in establishing the prognosis of patients with cirrhosis of the liver.     

Clinical need for both scintigraphy with technetium-99m GSA and per-rectal portal scintigraphy in some patients with chronic liver disease

Scintigraphy with 99mTc-diethylenetriaminepentaacetate with galactosyl human serum albumin (99mTc-GSA) and per-rectal portal scintigraphy are useful for evaluating hepatic functional reserve and portal circulation, respectively. We did the procedures simultaneously in some patients to examine the relationship between hepatic functional reserve and portal circulation in chronic liver disease. Scintigraphy with 99mTc-GSA was done in 10 healthy subjects, 45 patients with chronic hepatitis, and 165 patients with cirrhosis. Fifty-seven patients (13 with hepatitis and 44 with cirrhosis) also underwent per-rectal portal scintigraphy with 99mTc-pertechnetate within two weeks. A receptor index was calculated by dividing the radioactivity of the liver region of interest (ROI) by that of the liver-plus-heart ROI at 15 min after the injection of 99mTc-GSA. The index of blood clearance was calculated by dividing the radioactivity of the heart ROI at 15 min by that of the heart ROI at 3 min. A solution containing 99mTc-pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the liver and heart were recorded sequentially. A per-rectal portal shunt index was determined by calculating the ratio of counts for the liver to counts for the heart integrated for 24 seconds immediately after the appearance of the liver time-activity curve. The median receptor index was lower for more severe liver disorders, increasing in the order of chronic hepatitis, compensated cirrhosis and decompensated cirrhosis, and the median index of blood clearance was higher. The median receptor index was significantly lower when a complication (varices, ascites, or encephalopathy) was present, and the median index of blood clearance was higher. The shunt index was correlated significantly with the two other indices, but these values for some one-third of the patients disagreed in either indices. Scintigraphy with 99mTc-GSA and per-rectal portal scintigraphy with 99mTc-pertechnetate are both needed for accurate assessment of the severity of chronic liver disease before treatment-making decisions, because in some patients, results are not correlated.     

Brain iron detected by SWI high pass filtered phase calibrated with synchrotron X‐ray fluorescence

Purpose:

To test the ability of susceptibility weighted images (SWI) and high pass filtered phase images to localize and quantify brain iron.

Materials and Methods:

Magnetic resonance (MR) images of human cadaver brain hemispheres were collected using a gradient echo based SWI sequence at 1.5T. For X‐ray fluorescence (XRF) mapping, each brain was cut to obtain slices that reasonably matched the MR images and iron was mapped at the iron K‐edge at 50 or 100 μm resolution. Iron was quantified using XRF calibration foils. Phase and iron XRF were averaged within anatomic regions of one slice, chosen for its range of iron concentrations and nearly perfect anatomic correspondence. X‐ray absorption spectroscopy (XAS) was used to determine if the chemical form of iron was different in regions with poorer correspondence between iron and phase.

Results:

Iron XRF maps, SWI, and high pass filtered phase data in nine brain slices from five subjects were visually very similar, particularly in high iron regions. The chemical form of iron could not explain poor matches. The correlation between the concentration of iron and phase in the cadaver brain was estimated as c_Fe [μg/g tissue] = 850Δ? + 110.

Conclusion:

The phase shift Δ? was found to vary linearly with iron concentration with the best correspondence found in regions with high iron content. J. Magn. Reson. Imaging 2010;31:1346–1354. © 2010 Wiley‐Liss, Inc.

     

The pancreas in β-thalassemia major: MR imaging features and correlation with iron stores and glucose disturbunces

The study aims at describing the MR features of pancreas in beta-thalassemia major, investigating the relations between MR findings and glucose disturbances and between hepatic and pancreatic siderosis. Signal intensity ratios of the pancreas and liver to right paraspinous muscle (P/M, L/M) were retrospectively assessed on abdominal MR imaging studies of 31 transfusion-dependent patients with beta-thalassemia major undergoing quantification of hepatic siderosis and 10 healthy controls, using T1- (120/4/90), intermediate in and out of phase - (120/2.7, 4/20), and T2*-(120/15/20) weighted GRE sequences. Using the signal drop of the liver and pancreas on opposed phase images, we recorded serum ferritin and results of oral glucose tolerance test (OGTT). Decreased L/M and P/M on at least the T2* sequence were noticed in 31/31 and 30/31 patients, respectively, but no correlation between P/M and L/M was found. Patients with pathologic OGTT displayed a higher degree of hepatic siderosis (p < 0.04) and signal drop of pancreas on opposed phase imaging (p < 0.025), implying fatty replacement of pancreas. P/M was neither correlated with glucose disturbances nor serum ferritin. Iron deposition in the pancreas cannot be predicted by the degree of hepatic siderosis in beta-thalassemia major. Fatty replacement of the pancreas is common and may be associated with glucose disturbances.     

Helical CT of the liver with computer-assisted bolus-tracking technology: scan delay of arterial phase scanning and effect of flow rates

PURPOSE: The purpose of this work was to assess the scan delay and the effect of flow rates on arterial phase scanning of hepatic CT. METHOD: One hundred twenty patients suspected of having hepatocellular carcinoma were examined by three-phase helical CT using computer-assisted bolus-tracking technology. We set the region of interest (ROI) in the abdominal aorta at the level of the celiac artery as a baseline. The triggering threshold was set at 100 HU. A volume of 100 ml of iomeprol (350 mg of I/ml) was administered at 2, 2.5, or 3 ml/s i.v. RESULTS: In all cases, helical CT scanning began after reaching the ROI threshold. Then, portal venous phase scanning was initiated 50 s after arterial phase initiation. The mean delay time from the initiation of contrast agent administration to the beginning of arterial phase scanning was 29.2 +/- 3.8 s (mean +/- SD, range 22-39 s). A faster injection rate significantly shortened the scan delay (p < 0.01). In portal venous phase scanning, calculated areas under the hepatic enhancement curves were almost equal among different injection rates. CONCLUSION: The computer-assisted bolus-tracking technology is a useful method for determining an individual scan delay of arterial phase CT.     

3.0T MR磁敏感加权成像对多发性硬化患者脑静脉的研究

目的 探讨磁敏感加权成像(SWI)在检查多发性硬化(MS)患者大脑内静脉及属支和深部髓静脉改变中的价值.方法 对43例MS患者和年龄、性别相匹配的43名健康志愿者行常规了MRI和SWI,在43例MS患者中,5例病程<0.5年,17例病程0.5-2.0年,21例病程>2.0年.SWI所得静脉图像应用MinIP处理后,南2名有经验的医师双盲法评定MS患者大脑内静脉及其主要属支和深部髓静脉的改变,并与对照组比较.统计学分析采用Kruskal Wallis H 检验和Wilcoxon秩和检验.结果 43例MS患者中,23例为活动期,20例为稳定期.(1)大脑内静脉及其主要属支评分:23例活动期、20例稳定期MS患者及43名健康志愿者分别为(1.96±0.71)、(1.25±0.44)及(3.00±0.00)分,三者间差异均有统计学意义(H=67.65,P<0.01);活动期和稳定期MS患者均较对照组降低,差异有统计学意义(Z值分别为-6.67、-7.76,P值均<0.01),而活动期与稳定期MS患者比较差异也有统计学意义(Z=-3.35,P<0.01).(2)侧脑室体旁深部髓静脉改变:38例病程>0.5年的MS患者(17例病程0.5～2.0年、20例病程>2.0年)侧脑室体旁深部髓静脉减少、变短;5例病程<0.5年的MS患者侧脑室体旁深部髓静脉增多、延长.(3)"穿通静脉"表现:23例活动期MS患者中,35个侧脑室体旁强化病灶内"穿通静脉"明显扩张、延长;20例稳定期MS患者中,80个侧脑室体旁末强化病灶内"穿通静脉"变细、变短,但在3例患者中,6个侧脑室体旁未强化病灶内"穿通静脉"扩张、延长.结论 SWI能显示MS患者人脑内静脉及其属支和深部髓静脉改变,对了解MS的发病机制及病理改变具有重要价值.

Abstract：

Objective To explore the value of susceptibility weighted imaging (SWI) in detecting the changes of cerebral internal veins and their tributaries.especially the deep medullary veins,in the patients with multiple sclerosis(MS).Methods Conventional MRI and SWI were performed in 43 MS patients and 43 healthy volunteers(control group).Two groups were matched on gender and age.In the MS patients.the course of disease was less than 0.5 year in 5 paticnts,between 0.5 year and 2.0 years in 17 patients and more than 2.0 years in 21 patients.SWI venograms were obtained by performing minimum intensity projection(MinIP)reconstruction.Comparing with the control group,the changes of the cerebral internal veins,their main tributaries and the deep medullar veins in the MS patients were evaluated by 2 experienced radiologists with double blind methods.Kruskal Wallis H analysis and Wilcoxon rank test were used for statistics.Results In the 43 patients,23 had active MS(active group),20 had chronic MS (chronic group).(1)The mean score of the cerebral internal veins and their main tributaries was(1.96±0.71)for 23 active MS patients,(1.25±0.44)for 20 chronic MS patients and(3.00±0.00)for the control group,respectively.There were significant differences among the three groups(H=67.65,P<0.01).And the mean scores in the active and chronic MS patients were lower than that in the control group (1.96±0.71 vs 3.00±0.00,Z=-6.67.P<0.01:1.25±0.44 vs 3.00±0.00,Z=-7.76,P<0.01),the mean score in the active MS patients was higher than that in the chronic MS patients(Z=-3.35,P<0.01).(2)The deep medullar veins were shortened or diminished in 38 MS patients whose course of disease were more than 0. 5 year, and increased and prolonged in 5 MS patients whose course of disease were less than 0.5 year. (3) The " penetrating veins " were dilated and prolonged in 35 periventricular enhanced lesions in the 23 active MS patients, and thin and short in 80 periventricular non-enhanced lesions in the 20 chronic MS patients. However, in 3 chronic MS patients, slightly expanded and prolonged "penetrating veins" were detected in 6 periventricular non-enhanced lesions. Conclusion SWI can reveal the changes of the cerebral internal veins and their tributaries, especially the deep medullary veins, in different stages of MS patients, providing important information for pathogenesis and pathological study for MS patients.     

磁敏感加权成像在弥漫性轴索损伤诊断和分级中的临床应用

目的探讨磁敏感加权成像(susceptibility-weighted imaging,SWI)在弥漫性轴索损伤(diffuse axonal injury,DAI)的临床诊断和分级中的应用价值。资料与方法 26例DAI患者均行3.0 T MR检查,扫描序列包括T1WI、T2WI、液体衰减反转恢复(FLAIR)、扩散加权成像(DWI)及SWI,比较不同序列对DAI脑内病灶的显示率并分析其信号特征,评价SWI在DAI检查、诊断和分级中的作用。结果各序列显示脑内各部位DAI病灶平均检出数依次为:T1WI(0.327±0.910)、T2WI(0.523±1.332)、FLAIR(1.179±2.832)、DWI(1.417±3.579)、SWI(5.340±10.483),其中SWI序列检出DAI病灶的数目最多,共检出DAI出血灶833个,与T1WI、T2WI、FLAIR和DWI的差异有统计学意义(F值分别为12.42、14.29、15.34、20.36,P<0.001)。在SWI表现为斑点状或小结节低信号改变,位于白质及皮髓交界区病灶排列呈甩鞭样或串珠状,具有特征性。在SWI上,38.46%(10/26例)患者为DAI分级Ⅰ级,26.92%(7/26例)患者为DAI分级Ⅱ级,34.62%(9/26例)患者为DAI分级Ⅲ级,DAI分级与格拉斯哥昏迷评分(GCS)之间具有相关性(r=-0.759,P=0.00026),DAI的SWI分级能较好地反映DAI的损伤程度。结论SWI对DAI出血性病灶的检出具有较高的敏感性,能较常规MRI其他序列检出更多、更小病灶,其呈甩鞭样或串珠状排列更能体现DAI的损伤特点,较常规MRI序列更好地对DAI进行分级诊断,为临床预后提供重要依据。