SWI、DWI联合评价颈动脉斑块易损性的应用研究

摘要

目的:对比磁共振常规检查序列(T1WI、T2WI、PDWI)、磁敏感加权成像(SwI)、弥散加权成像(DWI)的图像质量,评价磁敏感加权成像、弥散加权成像在颈动脉斑块出血、早期炎症方面的应用价值.方法:①40例经超声诊断有颈动脉斑块的脑梗死患者先后使用磁共振进行磁共振常规检查技术(T1WI、T2WI、PDWI)和磁敏感加权成像(SWI)、弥散加权成像(DWI)的轴位扫描;②5种序列图像分别由两位副高级影像诊断医师对每幅图像质量情况进行技术评分,对具有诊断价值的图像进行评估;③判断有无颈动脉斑块出血或早期炎症.结果:①40例患者中,5个序列图像质量均具有诊断价值的有35例患者,其中T1WI、T2WI、PDWI、SWI、DWI组中,图像质量为3分以上者分别占90.0％、91.3％、92.5％、87.5％、88.8％,并且两位诊断医师的一致性较高,Kappa值均＞0.80,5种方法的图像质量差异无统计学意义(P＞0.05).②磁共振常规检查序列及SWI、DWI分别诊断斑块出血例数分别为8、17、9例.三种检查技术相互比较,SWI与磁共振常规序列及DWI检测斑块出血之间差异具有统计学意义.磁共振常规检查序列及DWI分别诊断斑块早期炎症例数分别为4、1 1例,两种检查技术相互比较,DWI与磁共振常规序列检测斑块早期炎症之间差异具有统计学意义.结论:①SWI显示颈动脉斑块出血优于常规序列和DWI,DWI与常规序列基本一致.②DWI显示颈动脉斑块早期炎症优于磁共振常规检查序列.③三种序列结合,能够更好地发现颈动脉斑块出血及早期炎症情况,判断斑块易损性,预警脑卒中.%Purpose:To compare the image quality of T1WI,T2WI,PDWI,susceptibility weighted imaging (SWI) and diffusion weighted imaging (DWI),and to evaluate the value of susceptibility weighted imaging and diffusion weighted imaging in evaluating the hemorrhage and early inflammation changes of carotid plaque.Methods:① Conventional magnetic resonance imaging (T1WI,T2WI,PDWI) and susceptibility weighted imaging (SWI),diffusion weighted imaging (DWI) were undergone in patients with cerebral infarction who were with carotid plaques detected by ultrasonography.② Two senior doctors evaluated the quality of the images obtained from each sequences.③ Finally,the images were evaluated to determine whether or not the carotid plaque was with hemorrhage or early inflammation changes.Results:① Of all the 40 patients,5 series images (T1WI,T2WI,PDWI,SWI,DWI)of 35 patients were with diagnostic value.The image quality of 90％,91.3％,92.5％,87.5％,88.8％ of these 5 series images was above 3 points.The results omong two senior doctors were with high consistency,Kappa value ＞0.80,no statistical significant difference was exist between these 5 sequences (P＞0.05).② Plaque hemorrhage was detected by conventional MRI,SWI and DWI in 8,17,9 cases,respectively.The detection rate of plaque hemorrhage were with statistical significant differences between SWI and conventional MRI,and between SWI and DWI.Plaque early inflammation changes were detected by conventional MRI,and DWI in 4,ll cases,respectively.The difference between DWI and conventional MRI in detection of early inflammation changes was with statistical significant.Conclusion:① Carotid plaque hemorrhage can be shown better by SWI than that by routine sequences and DWI.② Carotid plaque early inflammation changes can be shown better by DWI than that by routine sequences.③ The hemorrhage and early inflammation changes of carotid plaque can be better detected by the combination of SWI,DWI and routine sequences,and the plaque vulnerability can also be determined.