常规添加弥散加权成像儿童脑成像急性表现:初步经验

IF 0.1 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
S. Wahab, R. Khan, S. Siddiqui
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引用次数: 0

摘要

背景:许多影响儿童大脑的疾病对诊断提出了挑战。磁共振成像(MRI)被广泛认为是诊断脑缺血、脑炎和白细胞营养不良的敏感技术。常规实践中使用的常规MR序列包括T1加权(T1-W)、T2加权和流体衰减反演恢复(FLAIR)序列。然而,通常情况下,幼儿的表现令人困惑,即使在使用这些需要重复MRI检查的各种MR序列后,也会带来诊断挑战。检测微环境水平上发生的病理变化对于早期诊断、有效治疗和消除重复MRI的需要至关重要。目的:我们研究的目的是评估扩散加权成像(DWI)在更好地检测这些不同的大脑病理中的额外作用。设置和设计:这是一项前瞻性研究。受试者和方法:30名年龄从新生儿到12岁的儿童,在首次临床表现后72小时内,用MRI对其大脑进行评估。进行T1和T2自旋回波序列FLAIR和对比后T1-W成像。DWI采用深度分辨表面线圈光谱序列进行回声平面成像。根据DWI和常规序列对病变进行评估。最终诊断是根据临床评估、脑电图、影像学、脑脊液分析、血清学检查和血浆脂肪酸评估确定的。使用的统计分析:这是一项描述性研究。结果:将患者分为三组。A组包括DWI在表观扩散系数(ADC)图上检测到比传统MRI更多病变或病变程度更大的患者。该组有11例,其中7例为缺血性脑病,1例为肾上腺脑白质营养不良(ADL),病变范围增加,前进边缘扩散受限,3例为病毒性脑炎。在B组中,12例在DWI和常规MRI成像中具有相似的结果。其中,7例无特异性诊断且随后自发恢复的病例在常规和DWI上均未显示病变;5例DWI显示病变范围和数量相等;1例诊断为ADL,2例诊断为病毒性脑炎,2例最终诊断为缺血性脑病。在C组中,T2和FLAIR显示的病变比DWI多,有7例。5例ADC图正常,但在T2和FLAIR成像上有1-2个小的高信号病变,而其余两例被诊断为缺血性脑病的患者在T2和FLAIR序列上有高信号区域,并伴有心室增大和皮质萎缩,而DWI显示它们是T2,通过局灶性ADC值增加的区域发光。5例在T2和FLAIR上有高信号,但正常ADC图被标记为非特异性白质高信号。在研究期间,这些儿童既没有任何病变进展,也没有任何进一步的临床症状。结论:我们得出的结论是,DWI在检测早期病理变化方面比其他MR序列更敏感,即使在除缺血外的病毒性脑炎和脑白质营养不良的情况下也是如此。这也有助于在微观层面上更准确地描绘该区域。我们还能够从T2和FLAIR上的非特异性高信号中排除实际的病理学,在某些情况下DWI上也可以排除FLAIR。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Routine addition of diffusion-weighted imaging to pediatric brain imaging with acute presentation: An initial experience
Context: A number of disorders affecting the pediatric brain pose a diagnostic challenge. Magnetic resonance imaging (MRI) is widely accepted as a sensitive technique for the diagnosis of ischemia, encephalitis, and leukodystrophies. Conventional MR sequences used in routine practice include T1-weighted (T1-W), T2-weighted, and fluid-attenuation inversion recovery (FLAIR) sequences. However usually, the presentation in small children is confusing and presents a diagnostic challenge even after the use of these various MR sequences requiring repeated MRI examinations. Detecting pathological changes occurring at microenvironment level is vital for early diagnosis, effective treatment, and obviating the need of repeated MRI. Aims: The purpose of our study was to assess the additional role of diffusion-weighted imaging (DWI) in better detection of these various pathologies of brain. Settings and Design: This was a prospective study. Subjects and Methods: Thirty children of ages ranging from neonate to 12 years of age with various complaints of central nervous system involvement were evaluated with MRI brain within 72 h of initial clinical presentation. T1 and T2 spin-echo sequences FLAIR and postcontrast T1-W imaging were done. DWI was performed with echoplanar imaging using depth-resolved surface coil spectroscopy sequence. The lesions were evaluated on DWI and conventional sequences. The final diagnosis was established on the basis of clinical evaluation, electroencephalographic findings, imaging, cerebrospinal fluid analysis, serologic tests, and fatty acid evaluation in plasma assay. Statistical Analysis Used: This was a descriptive study. Results: The patients were divided into three groups. Group A included patients in whom DWI detected more lesions or showed a greater extent of lesions on apparent diffusion coefficient (ADC) map than conventional MRI. This group had 11 cases including 7 cases of ischemic encephalopathy, one case of adrenoleukodystrophy (ADL) showing increased extent of lesion with restricted diffusion at the advancing edge and 3 cases of viral encephalitis. In Group B, 12 cases had similar results in both DWI and conventional MRI imaging. Of these, 7 cases with no specific diagnosis and subsequent spontaneous recovery showed no lesion on both conventional and DWI; 5 cases showed equal extent and number of lesions on DWI; 1 case was diagnosed as ADL, 2 as viral encephalitis, and 2 as ischemic encephalopathy on final workup. In Group C, T2 and FLAIR showed more lesions than DWI and had 7 cases. 5 had normal ADC maps but 1–2 small hyperintense lesions on T2 and FLAIR imaging, while the remaining two diagnosed with ischemic encephalopathy had hyperintense areas on T2 and FLAIR sequences with associated ventricular enlargement and cortical atrophy while DWI revealed them to be T2 shine through areas with increased ADC value focally. The 5 cases with hyperintensity on T2 and FLAIR, but normal ADC maps were labeled as nonspecific white matter hyperintensities. These children showed neither any progress of lesion nor any further clinical symptoms during the duration of study. Conclusions: We concluded that DWI was more sensitive than the other MR sequences in detecting early pathological changes even in cases of viral encephalitis and leukodystrophy apart from ischemia. It was also helpful in delineating the area more accurately at the microscopic level. We were also able to rule out actual pathology from nonspecific hyperintensities on T2 and FLAIR in some cases on DWI.
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来源期刊
West African Journal of Radiology
West African Journal of Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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