弥漫性轴索损伤影像学分析

摘要

Objective To investigate imaging features of cerebral diffuse axonal injury ( DAI) and its diag-nostic value .Methods The clinical data , low field MRI data and CT imaging of 26 DAI patients enrolled from Sep.2010 to Sep.2015 were retrospectively analyzed .Among them 19 were males and 7 were females with an aver-age of 34.6(16-65) years.Twenty-two cases were injured from traffic accidents ,3 were from high falling and one was from heavy objects .All patients had trauma history .Patients developped immediate coma or continuous coma . According to the GCS score after hospitalization ,4(GCS≤8) were severe,6(9-12) were moderate and 16(13-15) were mild.Results All 26 patients were diagnosed with CT and low field MRI .The main manifestations were in-tracranial lesions in single or multiple sites .DAI lesions included hemorrhagic and non hemorrhagic lesions ,mainly distributed in the gray matter junction area ,basal ganglia area,thalamus,deep white matter,corpus callosum area, etc..The sensitivity of low field MRI was significantly higher than that of CT (χ2 =14.567,P=0.012).The GRE-T2*W1 sequence (97.59%) was the highest in all the sequences of hemorrhagic lesions ,and the DWI sequence (95.18%) was the highest in all the sequences of non hemorrahagic lesions .Conclusion The early diagnosis of DAI with CT and low field MRI is very valuable .The low field MRI can make up for the CT negative examination of the patients with heavy brain injury ,and can significantly improve the detection rate ,diagnosis rate ,and effectively a-void misdiagnosis and improve the prognosis .%目的：探讨弥漫性轴索损伤（ DAI）影像学表现及诊断价值。方法回顾性分析2010年9月～2015年9月26例DAI患者临床与CT、低场MRI资料，其中男性19例，女性7例；年龄16～65岁，平均34.6岁。患者均有创伤史，道路交通伤22例，高处坠落伤3例，重物打击伤1例。伤后均立即出现昏迷或持续昏迷，入院时格拉斯哥昏迷量化表（GCS）评分，重度（≤8分）4例，中度（9～12分）6例，轻度（13～15分）16例。结果26例均使用CT及低场MRI诊断，主要表现为颅内不同部位单发或多发点状病变，DAI病灶分为出血灶和非出血灶，主要分布在灰白质交界区、基底节区、丘脑、深部白质、胼胝体等区域。低场MRI敏感性明显高于CT（χ2＝14.567，P＝0.012），各序列中GRE-T2倡WI对出血灶检出数（97.59％）最高，DWI对非出血灶检出数（95.18％）最高。结论 CT及低场MRI对DAI的早期诊断很有价值，低场MRI能弥补CT检查阴性颅脑损伤而症状较重患者，能明显提高颅脑损伤的检出率、诊断率，能有效避免漏诊，提示预后。