SWAN技术在DAI诊断分级及预后评判中的应用研究

目的研究磁共振磁敏感加权血管成像（SWAN）技术对弥漫性轴索损伤（DAI）的诊断分级及预后评价。 方法选取自2013年1月至2015年3月收治于济南军区总医院神经外科符合纳入标准的50例DAI患者常规行核磁T1WI、T2WI、FLAIR、SWAN扫描，比较各系列之间病灶数目差异；将SWAN序列扫描结果结合患者GCS评分对DAI进行分级，进一步分析SWAN影像结果影响DAI患者分级及预后GOS评分的因素。 结果（1）SWAN对颅内微小出血灶数目检出率明显高于MRI常规序列T1加权成像、T2加权成像和流动衰减反转恢复序列（分别为985个对比53个，101个，204个，P<0.01）。（2）SWAN检出病灶累及部位、弥漫性脑水肿及脑干损伤程度等因素与DAI患者GCS评分分级呈正相关，与GOS评分分级呈负相关。（3）DAI预后呈两极分化状态，GCS评分分级越高，GOS评分越低、死亡风险值越大。 结论SWAN技术对DAI诊断分级及其预后评价具有很高的准确性和可靠性，可作为仅次于病理诊断的技术手段。

Application of SWAN technology in DAI diagnosis classification and prognosis evaluation

ObjectiveTo study the value of star weighted angiography (SWAN) in the diagnostic grading and prognostic evaluation of patients with brain DAI. MethodsFifty patients with brain DAI hospitalized in Department of Neurosurgery of Ji’nan Military General Hospital during 2013 January to 2015 March, were selected to receive 3.0T MRI, including sequences of T1WI、T2WI、FLAIR and SWAN. The number of the lesions and distributional characteristics in each sequence was analyzed. Furthermore, the correlativity of the grading and prognosis in patients with DAI in combination with GCS score and GOS score was also analyzed. Results(1) The detection rate of cerebral microbleeds through SWAN was significantly higher than that with the method of T1WI、T2WI and FLAIR. (2) SWAN detected lesion distribution, diffuse brain swelling and brain stem injury is closely related to the GCS score grading and GOS score. (3) The prognosis of DAI displayed polarization state, the higher grade of the GCS score, the lower of GOS score, and the greater value of the risk of death. ConclusionSWAN was a reliable method for the grading of clinical diagnosis and prognosis assessment in the patients of DAI after TBI, and the accuracy of diagnosis of DAI was second only to pathological diagnosis.