颅内海绵状血管瘤MRI-SWI T1WI T2FLAIR增强序列检查特征比较观察

doi:10.3969/j.issn.1006-6233.2024.07.012

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摘要 目的: 探讨磁共振敏感加权成像(MRI-SWI)、磁共振T1加权成像(T1WI)、T2加权成像(T2WI)、T2液体衰减反转恢复序列(T2FLAIR)在诊断颅内海绵状血管瘤中的应用价值。方法: 选取延安大学附属医院2019年3月至2023年3月初步诊断怀疑为颅内海绵状血管瘤患者153例作为研究对象,所有患者均在手术前完成了MRI检查,包括MRI-SWI、T1WI、T2WI、T2FLAIR检查,以手术病理学检查结果作为金标准,计算各种MRI检查方式对于诊断颅内海绵状血管瘤的价值。结果: MRI-SWI正确诊断97例海绵状血管瘤患者,共计准确检出病灶数量177个,T1WI正确诊断72例海绵状血管瘤患者,共计准确检出病灶数量121个,T2WI正确诊断77例海绵状血管瘤患者,共计准确检出病灶数量132个,T2FLAIR正确诊断82例海绵状血管瘤患者,共计准确检出病灶数量143个,MRI-SWI对海绵状血管瘤病灶的检出率高于T1WI、T2WI、T2FLAIR(χ²=28.698、P<0.05,χ²=22.299、P<0.05,χ²=16.257、P<0.05);T2FLAIR对海绵状血管瘤病灶的检出率高于T1WI(χ²=7.211、P<0.05);T1WI、T2WI对海绵状血管瘤病灶的检出率差异无统计学意义(χ²=1.676、P>0.05);T2FLAIR、T2WI对海绵状血管瘤病灶的检出率差异无统计学意义(χ²=1.972、P>0.05);T1WI海绵状血管瘤病灶主要表现为混杂信号(43.80%)、其次为低信号(30.58%);T2WI海绵状血管瘤病灶主要表现为混杂信号(49.24%),主要特征为病灶中央呈点状或网格状高信号,周围边缘低信号,称之为“铁环征”,其次为低信号(35.61%);T2FLAIR海绵状血管瘤病灶主要表现为类圆形或者圆形的混杂信号(58.33%),病灶内部显示为爆米花或者网格状,其次为低信号(34.09%);MRI-SWI海绵状血管瘤病灶主要表现为低信号(95.48%),主要显示病灶的周围含铁血黄素区域及瘤体,病灶周边及内部显示片状或点状低信号;T1WI、T2WI、T2FLAIR、MRI-SWI鉴别诊断海绵状血管瘤患者的灵敏度分别为74.23%、79.38%、84.54%、100%,特异度分别为85.71%、83.93%、78.57%、94.64%。结论: 颅内海绵状血管瘤患者在接受MRI检查的情况下,MRI-SWI序列较T1WI、T2WI、T2FLAIR序列具有更高的诊断价值。

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关键词 ：颅内海绵状血管瘤, 磁共振敏感加权成像, 磁共振T1加权成像, T2加权成像, T2液体衰减反转恢复序列

Abstract：Objective: To investigate the diagnostic value of magnetic resonance susceptibility-weighted imaging (MRI-SWI), T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and T2 fluid-attenuated inversion recovery (T2FLAIR) in intracranial cavernous hemangioma. Methods: From March 2019 to March 2023, 153 patients suspected of intracranial cavernous hemangioma were selected. All patients underwent preoperative MRI examinations, including MRI-SWI, T1WI, T2WI, and T2FLAIR. Surgical pathology results were used as the gold standard. The diagnostic values of the different MRI sequences were calculated. Results: MRI-SWI correctly diagnosed 97 patients with a total of 177 lesions, whereas T1WI correctly diagnosed 72 patients with 121 lesions, T2WI correctly diagnosed 77 patients with 132 lesions, and T2FLAIR correctly diagnosed 82 patients with 143 lesions. The detection rate of MRI-SWI for cavernous hemangiomas was significantly higher than that of T1WI, T2WI, and T2FLAIR (χ2=28.698, P<0.05; χ2=22.299, P<0.05; χ2=16.257, P<0.05). The detection rate of T2FLAIR was higher than that of T1WI (χ2=7.211, P<0.05). There were no significant differences in detection rates between T1WI and T2WI or between T2FLAIR and T2WI (χ2=1.676, P>0.05; χ2=1.972, P>0.05). MRI signal characteristics of cavernous hemangiomas varied among the sequences. T1WI mainly showed mixed signals (43.80%) and low signals (30.58%). T2WI mainly showed mixed signals (49.24%), characterized by central punctate or reticulated high signals with low-signal peripheral borders, known as the "iron ring sign," followed by low signals (35.61%). T2FLAIR mainly showed round or oval mixed signals (58.33%) with an internal appearance resembling popcorn or reticulation, followed by low signals (34.09%). MRI-SWI predominantly showed low signals (95.48%), highlighting iron deposition areas and tumor bodies with patchy or punctate low signals in and around the lesions. Sensitivity and specificity for diagnosing cavernous hemangiomas were as follows: T1WI had a sensitivity of 74.23% and specificity of 85.71%; T2WI had a sensitivity of 79.38% and specificity of 83.93%; T2FLAIR had a sensitivity of 84.54% and specificity of 78.57%; MRI-SWI had a sensitivity of 100% and specificity of 94.64%. Conclusion: MRI-SWI provides a higher diagnostic value for intracranial cavernous hemangiomas compared to T1WI, T2WI, and T2FLAIR sequences.

Key words： Intracranial cavernous hemangioma MRI susceptibility-weighted imaging T1-weighted imaging T2-weighted imaging T2 fluid-attenuated inversion recovery

基金资助:陕西省教育厅一般专项科学研究计划项目,(编号:20JG040)

通讯作者: 陈真

引用本文:

冯天保, 许超, 陈真. 颅内海绵状血管瘤MRI-SWI T1WI T2FLAIR增强序列检查特征比较观察[J]. 河北医学, 2024, 30(7): 1125-1130.
FENG Tianbao, XU Chao, et al. Comparative Observation of MRI-SWI T1WI T2WI and T2FLAIR in Diagnosing Intracranial Cavernous Hemangiomas. HeBei Med, 2024, 30(7): 1125-1130.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.07.012 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I7/1125

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