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目的通过多回波采集的重度T2*加权三维梯度回波序列(enhanced T2star weighted angiography,ES-WAN)对剪切出血灶的检出结果与弥漫性轴索损伤(diffuse axonal injury,DAI)相关体征如格拉斯哥昏迷量表(glas-gow coma scale,GCS)评分、昏迷时间以及瞳孔对光反射的相关性分析进一步评估ESWAN序列对DAI的诊断价值。方法 28例DAI患者入选本研究。采用ESWAN序列检出全脑出血灶和分区出血灶的数量、容积。分别按GCS评分、昏迷时间及瞳孔对光反射分组,对组间的全脑出血灶及分区出血灶的数量、容积采用秩和检验,检验其差异性。作全脑出血灶及分区出血灶的数量、容积与临床指标分级变量间的相关分析。结果 GCS评分较低组(≤8,n=16)、昏迷时间较长组(>4天,n=15)以及瞳孔对光反射有异常组(n=15)的全脑(P≤0.01)及额叶白质区、颞顶枕叶白质区、胼胝体、丘脑和脑干的分区(P≤0.05)出血灶数量和表观容积均明显增高。全脑出血灶的数量和表观容积与临床指标的分级变量间有显著的相关性(Spearman相关系数的绝对值变化范围为0.57～0.77)。额叶白质区、颞顶枕叶白质区、胼胝体、丘脑和脑干的分区出血灶数量和表观容积也和临床指标间有明显的相关性(Spearman相关系数的绝对值变化范围为0.44～0.83)。结论 ESWAN序列不仅能敏感检出DAI出血性剪切灶,而且其显示的结果与患者的有关意识障碍的临床指标有显著的相关性,是一项能有效、可靠地评估DAI出血灶的新的影像学方法。
OBJECTIVE: To compare the detection results of hemorrhagic lesions in hemorrhagic lesions with those of diffuse axonal injury (DAI) by using multiple T2-weighted weighted T2-weighted angiography (ES-WAN) Such as Glasgow Coma Scale (GCS) score, coma time, and pupil light reflex analysis to further evaluate the diagnostic value of ESWAN sequence on DAI. Methods Twenty-eight DAI patients were enrolled in this study. ESWAN sequence was used to detect the amount and volume of hemorrhagic foci of whole brain hemorrhage and subarea. Respectively by GCS score, coma time and pupil light reflex grouping, between the group of whole brain hemorrhagic foci and regional hemorrhagic foci number and volume using rank sum test to test the difference. For the whole brain hemorrhage and regional hemorrhage lesions volume, volume and clinical variables between the correlation analysis. Results Whole brain (P≤0.01) with abnormal GCS score (≤8, n = 16), long coma time (> 4 days, n = 15) and abnormal pupil light reflex (n = 15) And frontal white matter, temporal occipital lobe white matter, corpus callosum, thalamus and brain stem (P≤0.05), the number and apparent volume of hemorrhage were significantly increased. There was a significant correlation between the number of cerebral hemorrhagic foci and apparent volume and the grading variables of clinical indicators (Spearman’s correlation coefficient ranged from 0.57 to 0.77). The numbers and apparent volumes of regional hemorrhagic foci in frontal white matter, temporal occipital white matter, corpus callosum, thalamus and brain stem were also significantly correlated with clinical parameters (Spearman’s correlation coefficient ranged from 0.44 to 0.83 ). Conclusions ESWAN sequence can not only detect DAI hemorrhagic cutaneous lesions sensitively, but also show a significant correlation with clinical indicators of patients with disturbance of consciousness. It is a new and effective method to evaluate DAI hemorrhagic lesions Imaging method.