目的探讨磁敏感加权成像（susceptibility-weighted imaging,SWI）对早期创伤性脑损伤的诊断价值及其与格拉斯昏迷量表（Glasgow coma scale,GCS）评分的相关性。方法对40例临床诊断为早期创伤性脑损伤且颅脑CT检查结果阴性的患者行颅脑磁共振扫描，全部病例均行常规MRI(T1WI、T2WI、FLAIR）以及扩散加权成像（diffusion weighted imaging,DWI）、SWI序列检查，分析研究各序列上脑内损伤出血灶的检出率和分布情况。结果在40例患者中，磁共振常规序列共发现30个出血灶，在DWI上共发现46个出血灶，在SWI上共发现402个出血灶。出血灶分布于深部脑白质区、额颞叶皮髓质交界区、胼胝体、放射冠、基底节区、脑干及小脑等区域。GCS评分13～15分25例，9～12分12例，≤8分3例，GCS评分较低者其出血灶数较多，出血灶范围大者其GCS评分亦较低。SWI检出病灶数与其他多种检查差异有统计学意义（P＜0.001）。结论 SWI在早期创伤性脑损伤检查比常规则MRI能显示更多脑内微小出血灶，GCS评分高低与出血灶的多少及大小有明显相关性。%Objective To discuss the value of susceptibility weighted imaging(SWI) on the diagnosis of early traumatic brain injury, and its relativity to Glasgow coma scale (GCS) score. Method Cerebral MRI examination,including routine MRI sequence(T2WI,T1WI,FLAIR)and DWI,SWI sequence were performed in all 40 cases of patients who are diagnosed of early traumatic brain injury and with negative results of CT scan. The detection rate of patients with cerebral microscopic bleeding and the distribution of cerebral microscopic bleeding were analyzed and compared on each sequence.Result Among all patients, 30 lesions were detected on the routine MRI sequence , 46 lesions were detected on the DWI sequence , 402 lesions were detected on the SWI sequence.The bleeding lesions were located on the deep brain white matter area, the border zone of cortex and medulla in the frontal or temporal lobe,callosum, corona radiata, basal ganglia region, brainstem, cerebellar hemispheres.GCS scores were 13~15 in 25 cases; GCS scores were 9~12 in 12 cases; GCS scores in 3 cases were less than 8.The bleeding number was negative to the GCS scores,and also the bleeding range was negative to the scores. The difference between SWI and other sequences in the detection of lesions was statistically significant (P< 0.001).Conclusion SWI can detect more cerebral microscopic bleeding than other sequences on the early traumatic brain injury. The GCS score has obvious relevance with the number and size of cerebral microscopic bleeding.
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