Susceptibility weighted imaging in diagnostic and prognostic evaluation of severe hemorrhagic diffuse axonal injury

doi:10.3877/cma.j.issn.2095-9141.2017.03.003

Abstract

Abstract:

Objective

To assess the diagnostic value of susceptibility weighted imaging (SWI) for severe hemorrhagic diffuse axonal injury (DAI) and their correlation with evaluation of iniury severity and outcome.

Methods

Thirty patients with clinically diagnosed severe hemorrhagic DAI, from December 2013 to December 2015 in Department of Neurotrauma, First Hospital of Jilin University, underwent CT, routine T1 weighted imaging (T1WI), T2 weighted image (T2WI), fluid attenuated inversion recovery (FLAIR), DWI and SWI scanning. Respective signal characteristics and distribution features were detected. Number of DAI lesions detected in each sequence were compared and analyzed for correlation with GCS and GOS.

Results

By contrast, SWI provided relatively better detection of intracranial micro-hemorrhage lesions (P<0.05), and then DWI, FLAIR, T2WI, T1WI, CT. Lesion numbers on SWI and DWI were negatively correlated with GCS on admission and GOS at follow-up(P<0.05), moreover SWI had the better correlation. Lesion numbers on FLAIR, T2WI, T1WI and CT suspectively were negatively correlated with GCS on admission, but were not correlated with GOS at follow-up(P>0.05).

Conclusion

SWI can be pretty sensitive and effective to detect intracranial micro-hemorrhage lesions in severe hemorrhagic DAI patients and therefore supply more help for early diagnosis and treatment of severe hemorrhagic DAI as well as prognosis evaluation.

Key words: Susceptibility weighted imaging, Diffuse axonal injury, Magnetic resonance imaging, Micro-hemorrhage

Wenchen Li, Lei Liu, Bo Chen, Haifeng Wang, Shuanglin Fu. Susceptibility weighted imaging in diagnostic and prognostic evaluation of severe hemorrhagic diffuse axonal injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2017, 03(03): 136-141.

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Figures/Tables 5

References 24

[1]	Medana IM, Esiri MM. Axonal damage: a key predictor of outcome in human CNS diseases[J]. Brain, 2003, 126(Pt 3): 515-530.
[2]	Li XY, Feng DF. Diffuse axonal injury: novel insights into detection and treatment[J]. J Clin Neurosci, 2009, 16(5): 614-619.
[3]	余晖，刘静，沈桂权,等.联合DWI和常规MRI对非出血性弥漫性轴索损伤的诊断价值[J].临床放射学杂志, 2007, 26(7): 653-656.
[4]	王波定，王洪财，王东峰,等.弥散加权成像联合磁敏感加权成像在脑创伤性轴索损伤预后评估中的应用[J].中华老年医学杂志, 2013, 32(2): 145-148.
[5]	冯振广，李牧，夏爽,等.联合磁敏感加权成像和扩散加权成像对脑弥漫性轴索损伤的诊断和预后评价[J].中华创伤杂志, 2014, 30(1): 33-38.
[6]	徐玉芸，李梅，丁小龙,等.磁敏感加权成像在脑外伤中的应用[J].中国医学计算机成像杂志, 2010, 16(2): 97-100.
[7]	Yuan L, Wei X, Xu C, et al. Use of multisequence 3.0-T MRI to detect severe traumatic brain injury and predict the outcome[J]. Br J Radiol, 2015, 88(1052): 20150129.
[8]	Kou Z, Wu Z, Tong KA, et al. The role of advanced MR imaging findings as biomarkers of traumatic brain injury[J]. J Head Trauma Rehabil, 2010, 25(4): 267-282.
[9]	Tong KA, Ashwal S, Holshouser BA, et al. Diffuse axonal injury in children: clinical correlation with hemorrhagic lesions[J]. Ann Neurol, 2004, 56(1): 36-50.
[10]	Moenninghoff C, Kraff O, Maderwald S, et al. Diffuse axonal injury at ultra-high field MRI[J]. PLoS One, 2015, 10(3): e0122329.
[11]	季卫阳，陶晶晶，丁鸭锁,等.磁敏感加权成像术在急性弥漫性轴突损伤27例诊断中的应用[J].交通医学, 2012, 26(2): 621-623.
[12]	Tao JJ, Zhang WJ, Wang D, et al. Susceptibility weighted imaging in the evaluation of hemorrhagic diffuse axonal injury[J]. Neural Regen Res, 2015, 10(11): 1879-1881.
[13]	陶晶晶，张威江，汪桦,等.磁敏感加权成像对出血性弥漫性轴索损伤的诊断价值[J].中华创伤杂志, 2012, 28(4): 331-333.
[14]	陈浪，张菁，夏黎明,等.多回波采集T2*加权三维梯度回波序列在弥漫性轴索损伤出血性剪切灶检出中的应用[J].中华放射学杂志, 2011, 45(6): 547-551.
[15]	Pterakis K, Katantanas AH, Komnos A, et al. Outcome of patients with diffuse axonal injury: the significance and prognostic value of MRI in the acute phase[J]. J Trauma, 2000, 49(6): 1071-1075.
[16]	崔明惠. 3.0T MR磁敏感加权成像在外伤性脑损伤中的应用价值[J].天津医科大学学报, 2010, 16(4): 642-646.
[17]	黄崇权，徐立文，张丽敏,等.磁敏感加权成像联合弥散加权成像对脑创伤性轴索损伤病灶的检出及预后的Logistic分析[J].中国药物与临床, 2013, 13(12): 1582-1583.
[18]	张春锋，杨志永.磁敏感加权成像术对外伤性颅脑损伤的诊断价值[J].交通医学, 2014, 28(4): 344-346.
[19]	Liu J, Kou Z, Tian Y. Diffuse axonal injury after traumatic cerebral microbleeds: an evaluation of imaging techniques[J]. Neural Regen Res, 2014, 9(12): 1222-1230.
[20]	Park JH, Park SW, Kang SH, et al. Detection of traumatic cerebral microbleeds by susceptibility weighted image of MRI[J]. J Korean Neurosurg Soc, 2009, 46(4): 365-369.
[21]	Barnes SR, Haacke EM. Susceptibility weighted imaging: clinical angiographic applications[J]. Magn Reson Imaging Clin N Am, 2009, 17(1): 47-61.
[22]	Thomas B, Somasundaram S, Thamburaj K, et al. Clinical applications of susceptibility weighted MR imaging of the brain-a pictorial review [J]. Neuroradiology, 2008, 50(2): 105-116.
[23]	Shen Y, Kou Z, Kreipke CW, et al. In vivo measurement of tissue damage, oxygen saturation changes and blood flow changes after experimental traumatic brain Injury in rats using susceptibility weighted imaging[J]. Magu Reson Imaging, 2007, 25(2): 219-227.
[24]	赵秀芹，狄玉进，徐金法,等. 3.0T磁敏感加权成像在出血性弥漫性轴索损伤中的诊断价值[J].中华创伤杂志, 2012, 28(9): 790-793.

部位		病灶数	构成比（%）
表浅区		978	79.51
?	额叶灰质	174	14.15
?	额叶白质	193	15.69
?	颞顶枕叶灰质	453	36.83
?	颞顶枕叶白质	158	12.85
深部区		202	16.42
?	胼胝体	130	10.57
?	基底节	49	3.98
?	丘脑	23	1.87
后颅窝区		50	4.07
?	脑干	20	1.63
?	小脑	30	2.44

部位		病灶数	构成比（%）
表浅区		978	79.51
?	额叶灰质	174	14.15
?	额叶白质	193	15.69
?	颞顶枕叶灰质	453	36.83
?	颞顶枕叶白质	158	12.85
深部区		202	16.42
?	胼胝体	130	10.57
?	基底节	49	3.98
?	丘脑	23	1.87
后颅窝区		50	4.07
?	脑干	20	1.63
?	小脑	30	2.44

方法	检出数（±s）	t值
SWI	41.00±25.84	-
DWI	16.77±10.31^a	4.77
FLAIR	13.53±9.18^b	5.49
T2WI	11.17±8.11^c	6.03
T1WI	8.57±6.84^d	6.65
CT	5.63±5.27^e	7.34

方法	检出数（±s）	t值
SWI	41.00±25.84	-
DWI	16.77±10.31^a	4.77
FLAIR	13.53±9.18^b	5.49
T2WI	11.17±8.11^c	6.03
T1WI	8.57±6.84^d	6.65
CT	5.63±5.27^e	7.34

方法	病灶数	GOS评分		GCS评分
方法	病灶数	r值	P值	r值	P值
SWI	1 230	-0.534	0.002	-0.704	<0.001
DWI	503	-0.381	0.038	-0.592	0.001
FLAIR	406	-0.344	0.062	-0.571	0.001
T2WI	335	-0.322	0.083	-0.549	0.002
T1WI	257	-2.292	0.117	-0.517	0.003
CT	169	-0.270	0.148	-0.478	0.008

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