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目的比较常规磁共振成像(MRI)、液体衰减反转恢复(FLAIR)序列及弥散加权成像(DWI)检查技术对多发性硬化(MS)的诊断价值。方法58例MS患者,其中男性34例,女性24例,年龄4～70岁,平均年龄35.95岁。使用MRI进行T1加权、T2加权、FLAIR序列及弥散加权成像检查。将4种序列图像进行比较,同时使用软件进行DWI的弥散系数(ADC)及影像分析。结果①FLAIR序列共检出病灶877个,而T1WI、T2WI和DWI分别检出病灶651、776和537个,分别为FLAIR序列检出病灶数的74%、88%和61%。各成像序列对病灶的检出率之间的差异有显著统计学意义(P<0.0001)。②MS病灶主要分布在脑室周围白质和半卵圆中心区,占总病灶数的96.1%。其中分布在脑室周围白质的病灶数与半卵圆中心区者相比,差异无统计学意义(P>0.05),而与脑干、小脑和胼胝体相比,差异均有显著统计学意义(均P<0.01)。③T1WI信号多为低信号、略低信号和等信号,T2WI及FLAIR序列为高信号,DWI在急性期病灶显示为略高信号影,在慢性期可表现为等信号或低信号。④MS急性期病灶平均ADC与急性脑梗死相比差异无统计学意义(P>0.05)。亚急性和慢性期平均ADC高于脑缺血的ADC(P<0.001),但低于脑肿瘤的ADC(P<0.05)。结论对MS病灶的阳性检出率,FLAIR序列优于其余3个序列;DWI可以较好地区分MS病灶分期,同时应用DWI、ADC检查对判别病灶的性质、鉴别诊断有较大帮助,是诊断MS等脱髓鞘疾病的有效影像学方法。
Objective To compare the diagnostic value of routine magnetic resonance imaging (MRI), fluid attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) in the diagnosis of multiple sclerosis (MS). Methods 58 cases of MS patients, including 34 males and 24 females, aged 4 to 70 years, mean age 35.95 years. T1-weighted, T2-weighted, FLAIR sequences and diffusion-weighted imaging were performed using MRI. Four kinds of sequence images were compared, and DWI diffusion coefficient (ADC) and image analysis were performed simultaneously. Results ① There were 877 lesions detected by FLAIR and 651, 776 and 537 lesions detected by T1WI, T2WI and DWI respectively, which were 74%, 88% and 61% of those detected by FLAIR. There was a statistically significant difference in the detection rates of lesions between imaging sequences (P <0.0001). ② MS lesions were mainly distributed in the periventricular white matter and semi-oval central area, accounting for 96.1% of the total number of lesions. There was no significant difference in the number of white matter lesions distributed in the periventricular space between the patients with centrioles and the central part of the semiovale (P> 0.05), while the difference was statistically significant compared with the brainstem, cerebellum and corpus callosum P <0.01). ③TWI signal mostly low signal, slightly lower signal and equal signal, T2WI and FLAIR sequence is high signal, DWI showed slightly higher signal in acute phase lesions, can be expressed in the chronic phase as the signal or low signal. (4) There was no significant difference in the average ADC between MS acute stage and acute cerebral infarction (P> 0.05). The average ADC of subacute and chronic phases was higher than that of cerebral ischemia (P <0.001), but lower than that of brain tumors (P <0.05). Conclusion The detection rate of FLSIR is superior to FLAIR sequences in the detection of MS lesions. DWI can distinguish MS staging well. DWI and ADC can be helpful in distinguishing the lesions and differentiating the lesions MS and other demyelinating diseases effective imaging method.