磁敏感加权成像相位图病灶信号强度鉴别单纯出血或钙化失败的影响因素研究

doi:10.3969/j.issn.1673-5765.2022.10.007

摘要/Abstract

摘要：

目的旨在统计SWI相位图病灶本身信号强度（直接征象）鉴别单纯出血或钙化发生错判的概率，并通过logistic回归分析确定错判的独立影像学危险因素，为影像及临床医师鉴别诊断提供依据。

方法回顾性分析2016-2019年首都医科大学附属北京天坛医院单纯出血或钙化病例，连续性入组。将SWI图像进行标准化，即将左手图变成右手图。含有多个病灶者，所有病变逐个评估。两名观察者直观定性评估SWI相位图数据：低、高信号或无法判断（混杂或等信号），预测病变为出血或钙化。与CT诊断“金标准”进行对比，预判结果与CT结果不一致者认定为失败组，一致者为成功组。评估的临床及影像学影响因素包括年龄、性别、病灶直径、平均CT值、T1WI和T2WI信号、SWI相位图病灶本身信号强度（直接征象）、左右手图、病灶位置、侧别、单多发及病灶性质。采用logistic回归分析SWI相位图病灶本身信号强度法鉴别失败的影响因素。

结果共纳入受试者41例，病灶339个，钙化及出血病灶分别为157个及182个。失败组105个病灶，成功组234个病灶。通过SWI相位图病灶本身信号强度（直接征象）错判率为30.97%。多因素logistic回归分析显示，SWI相位图等或混杂信号（OR 97.263，95%CI 28.746～329.096，P<0.001）、SWI相位图高信号（OR 5.684，95%CI 2.042～15.819，P=0.001）、T2WI低或混杂信号（OR 5.024，95%CI 2.391～10.558，P<0.001）、CT值91～300 Hu（OR 2.710，95%CI 1.023～7.180，P=0.045）及病灶直径>4 mm（OR 2.437，95%CI 1.168～5.084，P=0.018）是导致SWI相位图病灶本身信号强度（直接征象）错判的独立危险因素。

结论 SWI相位图病灶高或混杂信号者、T2WI低或混杂信号者、CT值91～300 Hu者及病灶直径>4 mm者采用SWI相位图病灶本身信号强度（直接征象）方法鉴别单纯出血及钙化错误风险高，对临床及影像学诊断有一定指导作用。

文章导读： 病灶直径>4 mm、T2WI低或混杂信号、SWI相位图高或混杂信号及CT值较高，是SWI相位图病灶信号强度鉴别单纯出血或钙化错判的独立危险因素，可考虑结合间接征象即极晕征法进行鉴别诊断，提高诊断正确率。

关键词: 磁敏感加权成像; 相位; 出血; 钙化

Abstract:

Objective To investigate the influencing factors for false differentiating simple hemorrhage from calcification by cerebral lesion signal intensity on SWI phase image.

Methods This retrospective analysis enrolled the consecutive patients with simple calcifications and/or microhemorrhage on head SWI phase image at Beijing Tiantan Hospital, Capital Medical University between 2016 and 2019. Follow-up CT scan was taken as the gold standard. The evaluation standard on right handed SWI phase image: low and high intensity signal sign for hemorrhage and calcification, respectively. The clinical and imaging parameters included gender, age, lesion side, location, diameter, single or multiple lesions, lesion nature, CT value, T1WI and T2WI signal, lesion signal intensity on SWI phase image, left- or right-handed MR image. Multivariate logistic regression analysis was used to analyze the influencing factors for false differentiating the lesions.

Results A total of 339 lesions from 41 cases were analyzed, including 157 hemorrhage lesions and 182 calcification lesions. 234 lesions were correctly diagnosed and 105 lesions were incorrectly diagnosed, and the false diagnosis rate was 30.97% by the signal intensity on SWI phase image. Multivariate logistic regression analysis showed that equal or mixed signal intensity (OR 97.263, 95%CI 28.746-329.096, P<0.001) and high signal intensity (OR 5.684, 95%CI 2.042-15.819, P=0.001) on SWI phase image, low or mixed signal intensity on T2WI (OR 5.024, 95%CI 2.391-10.558, P<0.001), lesion diameter larger than 4 millimeter (OR 2.437, 95%CI 1.168-5.084, P=0.018), CT value among 91-300 Hu (OR 2.710, 95%CI 1.023-7.180, P=0.045) were independent influencing factors for false diagnosis.

Conclusions The patients with mixed or high signal intensity on SWI phase image, low or mixed signal intensity on T2WI, lesion diameter larger than 4 millimeter, CT value among 91-300 Hu are prone to leading to false diagnosis of simple hemorrhage and calcification by lesion signal intensity on SWI phase image.

Key words: Susceptibility weighted imaging; Phase image; Hemorrhage; Calcification

苏录, 高培毅. 磁敏感加权成像相位图病灶信号强度鉴别单纯出血或钙化失败的影响因素研究 [J]. 中国卒中杂志, 2022, 17(10): 1082-1088.

SU Lu, GAO Peiyi. Influencing Factors of False Differentiating Simple Hemorrhage from Calcification by Signal Intensity of Cerebral Lesions on SWI Phase Image[J]. Chinese Journal of Stroke, 2022, 17(10): 1082-1088.

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