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。

The diagnostic and differential diagnostic value of susceptibility weighted imaging in brain multiple sclerosis

Objective To compare the phase values of susceptibility weighted imaging（SWI） between multiple sclerosis（MS）,cerebral infarction and normal control subjects and to explore the diagnostic value of phase values in the patients with MS.Methods Twelve patients with MS,who were confirmed by clinical diagnosis and/or laboratory tests,20 patients with cerebral infarction and 30 healthy volunteers as control group underwent brain scans using magnetic resonance imaging,which included conventional MR imaging and SWI.Results The phase values of regions of interests were no significantly difference between gender,sides,and ages.The phase values of bilateral frontal white matter were lower than other regions,although there was no significantly statistical difference between them.Paired t-test analysis showed the phase values of MS in the white matter of bilateral frontal lobe,parietal lobe,occipital lobe,brain stem and cerebellum were lower than the control group,but the phase values of frontal lobe and occipital lobe were significantly lower（P0.05）.The phase values of the lesions of cerebral infarction were lower than the control group,but there was no significantly difference between them,while the phase values between MS and cerebral infarction were no significantly differences.Compared with the cerebral infarction,the phase values of lesions in MS were significantly lower than those of the control group（P0.05）.In addition,among the 227 lesions of 12 patients with MS,there were 126 lesions with veins in the surrounding area,56 lesions exhibited low signal in the surrounding area,and the lesions of all 20 patients with cerebral infarction had no similar findings.Conclusion SWI can improve awareness of the pathological features of the multiple sclerosis and cerebral infarction in vivo and understanding of differential diagnosis between them.To some extent,it also can be used as a quantitative complement to guide the clinical treatment options.