劉建雄 江 敏 林雅芳
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磁敏感加權(quán)成像對(duì)單純性腦出血和腦腫瘤卒中的鑒別診斷
劉建雄 江 敏 林雅芳
目的 分析磁敏感加權(quán)成像技術(shù)對(duì)單純性腦出血和腦腫瘤卒中的鑒別診斷意義。方法 選擇2011年腦出血患者77例,其中包括單純性腦出血46例,腦腫瘤卒中31例,均進(jìn)行磁共振增強(qiáng)和磁敏感加權(quán)成像檢查。結(jié)果 46例單純性腦出血中,31例邊緣出現(xiàn)輕度強(qiáng)化,15例沒有出現(xiàn)明顯的強(qiáng)化;磁敏感加權(quán)成像掃描檢查發(fā)現(xiàn)46例病變周圍均沒有出現(xiàn)明顯迂曲增粗腫瘤樣的血管樣低信號(hào)。31例腦腫瘤卒中患者中,有19例邊緣出現(xiàn)輕度強(qiáng)化,12例沒有出現(xiàn)明顯的強(qiáng)化;13例結(jié)節(jié)腫塊型者,局部未出血部位出現(xiàn)迂曲增粗低信號(hào),11例灶樣出血者,在未出血的腫物部位出現(xiàn)迂曲增粗低信號(hào),6例環(huán)型者,出現(xiàn)增粗低信號(hào)。磁敏感加權(quán)成像的確診率為68.83%,明顯高于磁共振增強(qiáng)的53.25%(P<0.05)。結(jié)論 磁敏感加權(quán)成像能提高單純性腦出血和腦腫瘤卒中的鑒別診斷正確率,值得臨床應(yīng)用推廣。
磁敏感加權(quán)成像;磁共振增強(qiáng);單純性腦出血;腦腫瘤卒中
(ThePracticalJournalofCancer,2016,31:1893~1895)
腦腫瘤出血量較多時(shí),腫瘤實(shí)質(zhì)部分易被掩蓋,易與單純性腦出血相混淆,難以鑒別診斷而造成誤診,從而耽誤了最佳的治療時(shí)機(jī)[1-2]。磁敏感加權(quán)成像是通過利用不同組織間相位信息及磁敏感性的差異產(chǎn)生圖像對(duì)比的磁共振成像法,鑒別診斷小出血、小血管、血栓和鈣化,對(duì)血紅蛋白產(chǎn)物、靜脈血管、鐵含量的異常尤為敏感[3-4]。目前臨床主要應(yīng)用于顱腦疾病的檢查,在腦血管病、腦腫瘤、神經(jīng)變性疾病和腦外傷等方面具有較高的應(yīng)用價(jià)值[5]。本文主要研究了磁敏感加權(quán)成像技術(shù)對(duì)單純性腦出血和腦腫瘤卒中的鑒別診斷意義,現(xiàn)報(bào)告如下。
1.1 一般資料
77例腦出血患者來自我院2011年3月至2015年12月,包括單純性腦出血46例,腦腫瘤卒中31例,其中18例單純性腦出血經(jīng)保守治療隨訪吸收而證實(shí),余28例單純性腦出血及31例腦腫瘤卒中均經(jīng)病理學(xué)診斷證實(shí);男性33例,女性34例;年齡26~73歲,平均(41.58±12.43)歲。本研究獲得我院倫理委員會(huì)的批準(zhǔn),所有患者均簽署知情同意書。
1.2 方法
應(yīng)用美國(guó)GE3T超導(dǎo)磁共振儀,對(duì)所有患者進(jìn)行磁共振增強(qiáng)和磁敏感加權(quán)成像檢查,參數(shù)設(shè)置為:FSE T2WI軸位:TE=98.0 ms,TR=4000 ms;GRE T1WI軸位:TE=4.8 ms,TR=195.0 ms;SE T1WI矢狀位:TE=8.4 ms,TR=550.0 ms;FLAIR軸位:TE=84.0 ms,TR=8200 ms;T1 FLAIR 矢狀位:TE=24 ms,TR=1875 ms,TI=860 ms;T1 FLAIR軸位: TE=24 ms,TR=1875 ms,TI=860 ms;T1 FLAIR 冠狀位:TE=24 ms,TR=1875 ms,TI=860 ms;層間隔為1.2 mm,層厚為6.0 mm。
1.3 統(tǒng)計(jì)學(xué)分析
應(yīng)用SPSS 15.00軟件,組間率的比較用χ2檢驗(yàn),以P<0.05表明差異有統(tǒng)計(jì)學(xué)意義。
2.1 單純性腦出血的MR表現(xiàn)
9例出血部位在半卵圓中心,13例在額葉,4例在基底節(jié)區(qū),20例在枕葉。14例信號(hào)呈等長(zhǎng) T1短T2;28例信號(hào)呈不均勻短 T1長(zhǎng)T2;4例信號(hào)呈不均勻等 T1長(zhǎng)T2。32例發(fā)現(xiàn)周圍有不同程度的水腫信號(hào),14例未發(fā)現(xiàn)周圍有水腫。增強(qiáng)掃描檢查發(fā)現(xiàn)31例邊緣出現(xiàn)輕度強(qiáng)化,15例沒有出現(xiàn)明顯的強(qiáng)化。磁敏感加權(quán)成像掃描檢查發(fā)現(xiàn)46例病變周圍均沒有出現(xiàn)明顯迂曲增粗腫瘤樣的血管樣低信號(hào)。
2.2 腦腫瘤出血的MR表現(xiàn)
8例出血部位在顳葉,11例在額葉,6例在小腦,6例在枕葉。11例出血為灶樣出血,13例出血為結(jié)節(jié)腫塊型,6例出血為環(huán)型。16例信號(hào)呈不均勻等 T1長(zhǎng) T2信號(hào),15例信號(hào)呈短 T1、長(zhǎng)短 T2信號(hào)。3例周圍沒有出現(xiàn)明顯水腫,17 例周圍出現(xiàn)水腫。增強(qiáng)掃描檢查發(fā)現(xiàn)有19例邊緣出現(xiàn)輕度強(qiáng)化,12例沒有出現(xiàn)明顯的強(qiáng)化。磁敏感加權(quán)成像掃描檢查發(fā)現(xiàn):13例結(jié)節(jié)腫塊型者,局部未出血部位出現(xiàn)迂曲增粗低信號(hào);11例灶樣出血者,在未出血的腫物部位出現(xiàn)迂曲增粗低信號(hào);6例環(huán)型者出現(xiàn)增粗低信號(hào)。
2.3 磁共振增強(qiáng)和磁敏感加權(quán)成像臨床診斷情況的比較
采用磁敏感加權(quán)成像的確診率為68.83%,明顯高于磁共振增強(qiáng)的(53.25%)(P<0.05),見表1。
表1 磁共振增強(qiáng)和磁敏感加權(quán)成像臨床診斷情況比較/例
與磁共振增強(qiáng)相比,*為P<0.05。
腦出血是神經(jīng)科的常見急癥,腦腫瘤卒中常侵及周圍腦組織形成蛛網(wǎng)膜下腔出血或顱內(nèi)血腫,臨床上較為多見,其出血量較多時(shí),常常會(huì)掩蓋腫瘤本身,與單純性腦出血相混淆。臨床上如能盡早發(fā)現(xiàn)、鑒別和診斷,就能采取及時(shí)有效的治療,預(yù)防或減少腦出血的發(fā)生,并避免并發(fā)癥的產(chǎn)生,從而使患者的生活質(zhì)量得到提高。磁敏感加權(quán)成像是1種全新的磁共振成像技術(shù),具有三維、高分辨率和高信噪比等特點(diǎn)[6]。磁敏感加權(quán)成像通過利用高分辨率、長(zhǎng)回波時(shí)間、完全性流動(dòng)補(bǔ)償和薄層重建的梯度回波伴濾過的相位信息,從而增加組織間的磁敏感差異和磁矩圖的對(duì)比度,最大化磁敏感效應(yīng)的敏感性[7-8]。隨著磁共振技術(shù)的不斷發(fā)展,臨床磁敏感加權(quán)成像的應(yīng)用范圍也不斷的擴(kuò)展,多用于檢測(cè)血管畸形、出血、腫瘤、外傷、退行性神經(jīng)疾病、血管性疾病和與鐵沉積相關(guān)的疾病[9]。
因常規(guī)磁共振成像沒有明顯的信號(hào)特征,對(duì)鈣化不敏感,對(duì)出血常不能做出準(zhǔn)確的診斷,在常規(guī)序列的明確檢出出血通常要到亞急性期,在急性期因?yàn)樾盘?hào)的改變不明顯而不能做出診斷。而磁共振增強(qiáng)也需要數(shù)小時(shí)才能發(fā)現(xiàn)出血,并且極易因折疊、擴(kuò)張的血管導(dǎo)致的出血灶微小和假陽性而造成漏診[10]。磁敏感加權(quán)成像對(duì)出血非常敏感,在出血早期就能有信號(hào)的改變,所顯示出血的范圍和數(shù)量要比磁共振增強(qiáng)大、多,并能顯示比磁共振增強(qiáng)難以顯示的<10 mm2的小病灶[11-12]。磁敏感加權(quán)成像對(duì)腦出血病人的診斷主要包括出血的早期診斷與微量出血灶的檢出兩個(gè)方面[13]。
腦腫瘤的重要標(biāo)志為腫瘤血管的生成,與正常血管相比較,腫瘤血管的特點(diǎn)是結(jié)構(gòu)雜亂無章,發(fā)育不成熟,沒有形成正常的分支和分級(jí),管腔粗細(xì)不規(guī)則,組織間液的壓力增高,血流較紊亂,血流受阻。常規(guī)磁共振成像檢查不能完整顯示腫瘤的內(nèi)部結(jié)構(gòu),腫瘤內(nèi)的出血、新生血管和鐵的沉積,雖然磁共振增強(qiáng)可以顯示出腫瘤的血液供應(yīng)狀況,但卻不能清楚顯示腫瘤的新生血管[14]。與磁共振增強(qiáng)相比,磁敏感加權(quán)成像可以更為清晰的顯示腫瘤的出血產(chǎn)物、邊界、水腫和靜脈組織結(jié)構(gòu)等,并作出評(píng)估,區(qū)分瘤內(nèi)出血和鈣化,指導(dǎo)腫瘤放療[15]。磁敏感加權(quán)成像在腫瘤方面的應(yīng)用主要包括評(píng)估腫瘤血氧水平的改變,腫瘤靜脈成像和檢測(cè)腫瘤血紅蛋白分解產(chǎn)物。本研究采用磁敏感加權(quán)成像鑒別診斷單純性腦出血和腦腫瘤卒中的確診率為68.83%,明顯高于磁共振增強(qiáng)的53.25%(P<0.05),證實(shí)了磁敏感加權(quán)成像對(duì)單純性腦出血和腦腫瘤卒的鑒別診斷價(jià)值。分析其原因,可能為磁共振增強(qiáng)掃描只能觀察到腫瘤邊緣的血腦屏障破壞程度與腫瘤內(nèi)部的囊變壞死情況,而在顯示腫瘤血管方面,磁敏感加權(quán)成像具有明顯的優(yōu)勢(shì)。
綜上所述,磁敏感加權(quán)成像能提高單純性腦出血和腦腫瘤卒中的鑒別診斷正確率,值得臨床應(yīng)用推廣。
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(編輯:吳小紅)
Magnetic Susceptibility Weighted Imaging in the Differential Diagnosis of Simple Cerebral Hemorrhage and Brain Tumor Stroke
LIUJianxiong,JIANGMin,LINYafang.
NingdeMunicipalHospital,Ningde352100
Objective To investigate the value of magnetic susceptibility weighted imaging in the differential diagnosis of simple cerebral hemorrhage and brain tumor stroke.Methods 77 cases of cerebral hemorrhage were selected,including 46 cases of simple cerebral hemorrhage,and 31 cases of brain tumor stroke.Patients were checked by nuclear magnetic resonance enhancing and magnetic susceptibility weighted imaging.Results Among 46 cases of simple cerebral hemorrhage,the edge of 31 cases appeared mild reinforcement,15 cases did not appear obvious reinforcement;magnetic susceptibility weighted imaging scans found 46 cases have no obvious enlargement of circuity around tumor vascular sample low signal.Among 31 cases of brain tumor stroke,19 cases appeared mild reinforcement,12 cases had no obvious reinforcement;13 cases of nodular tumor type,appeared circuity enlargement low signal,11 cases with focal bleeding,without bleeding lesions appeared circuity enlargement low signal,6 cases of ring,enlargement of low signal.The diagnostic rate of magnetic susceptibility weighted imaging was 68.83%,which was significantly higher than that of nuclear magnetic resonance enhancing,53.25% (P<0.05).Conclusion Magnetic susceptibility weighted imaging can improve the differential diagnostic accuracy of simple cerebral hemorrhage and brain tumor stroke,it is worthy of clinical promotion.
Magnetic susceptibility weighted imaging;Nuclear magnetic resonance enhancing;Simple cerebral hemorrhage;Brain tumor stroke
352100 福建醫(yī)科大學(xué)附屬寧德市醫(yī)院
10.3969/j.issn.1001-5930.2016.11.047
R739.41
A
1001-5930(2016)11-1893-03
2016-04-01
2016-10-12)