The Value Of 3D SWAN And 3D ASL In Patients With Acute Mild Traumatic Brain Injury

Objectives The lesions of acute mild traumatic brain injury patients were divided into hemorrhagic lesions and non-hemorrhagic lesions.To investigate whether 3D SWAN(three dimensions T2* weighted angiography)can detect more hemorrhagic lesions than MR routine sequences.To investigate whether 3D ASL(three dimensions arterial spin labeling)can detect more non-hemorrhagic lesions than MR routine sequences.To explore whether the combination of 3D SWAN and 3D ASL can evaluate the brain damage of m TBI patients comprehensively compared with MR routine sequence.Methods In 54 cases of acute mTBI patients who met the selection criteria and exclusion criteria,One-stop scanning of MR routine sequences(DWI is included in the routine sequence),3D SWAN and 3D ASL were applied to within 72 hours after injury.The image data were processed by GE Function 5×2.1.08 software package,and the number,distribution and positive rate were counted and compared.Analysis of their respective imaging characteristics.The 54 patients were divided into group I(MR routine sequences),group II(3D SWAN),group III(3D ASL)and group IV(the combination of 3D SWAN and 3D ASL).The patients' brain lesions were divided into hemorrhagic lesions and nonhemorrhagic lesions.The following comparative analysis was made:(1)The difference of the positive rate between group I and group I,group I and group I,group I and group IV was compared and analyzed.(2)Comparison of the number of hemorrhagic lesions detected between group I and II.(3)Compare the difference between group I and II in detecting small hematoma size <5mm.(4)The difference of the number of nonhemorrhagic lesions detected between group I and III was analyzed.(5)According to the results of comparative analysis of articles(2)?(3)?(4),the differences between group I and IV were analyzed.SPSS22.0 software was used in statistical treatment.Mc Nemar test was used to compare the rate of positive patients between groups.The comparison of the number of pathological changes between groups was compared with the Wilcoxon sign rank test,and the difference was statistically significant in P < 0.05.Results 1 There were 46 positive lesions in the group I.The hemorrhagic lesion was manifested as local small hematoma and subarachnoid hemorrhage in 23 places,of which there were 11 small hematomas of ?5mm,and 4 small hematoma of<5mm.8 cases of subarachnoid hemorrhage.There were 43 places of non-hemorrhagic lesions,which were characterized by edema around small hematoma and cerebral contusion without hematoma.2 There were 73 hemorrhagic lesions in the group II.There were 11 hematomas of ?5mm,51 hematomas of<5mm,and 11 cases of subarachnoid hemorrhage.3 There were 92 abnormal areas of perfusion in the group III,including 81 local hypoperfusion areas and 11 local hyperperfusion areas.There were 70 local hypoperfusion areas and 11 local hyperperfusion areas in cerebral contusion or hematoma,and 11 hypoperfusion areas in nocontusion and hematoma.4 There were 165 positive lesions in the group IV.Including 73 hemorrhagic lesions and 92 non-hemorrhagic lesions.5 The imaging findings of the positive lesions detected in each sequence were characteristic,closely related to the pathological changes of m TBI,and the distribution of the lesions was roughly similar.6 The rate of positive patients in group II(77.78%)was significantly higher than that in group I(46.30%),and the difference was statistically significant(S=17,P<0.0001).The rate of positive patients in group III(94.44%)was significantly higher than that in group I(46.30%),and the difference was statistically significant(S=26,P<0.0001).The rate of positive patients in group IV(94.44%)was significantly higher than that in group I(46.30%),and the difference was statistically significant(S=26,P<0.0001).The number of hemorrhagic lesions in group I(23 places)was significantly less than that in group II(73 places),and the difference was statistically significant(Z=-5.151,P=0.000).The number of small hematomas of<5mm in group I(4 places)was significantly less than that in group II(51 places),and the difference was statistically significant(Z=-5.372,P=0.000).The number of non-hemorrhagic lesions in group I(43 places)was significantly less than that in group III(92 places),and the difference was statistically significant(Z=-5.491,P=0.000).The number of hemorrhagic lesions in group IV was also the number of hemorrhagic lesions in group II(73),and the number of non-hemorrhagic lesions was also the number of non-hemorrhagic lesions in group III(92),which were significantly more than those in group I.Conclusions 1 The 3D SWAN can detect more hemorrhagic lesions than the MR routine sequence,especially for small hematoma with diameter less than 5 mm.2 The 3D ASL can detect more non-hemorrhagic lesions than the MR routine sequence.There are abnormal perfusion regions in or around the site of cerebral contusion and hematoma,mostly local hypoperfusion areas and rarely local hyperperfusion areas;There may also be local hypoperfusion areas in the area of no cerebral contusion or hematoma.3 Compared with MR routine sequences,3D SWAN and 3D ASL can detect more hemorrhagic and nonhemorrhagic lesions.These lesions can be divided into three cases: hemorrhagic lesions show local hypoperfusion areas,hemorrhagic lesions show local hyperperfusion areas and non-hemorrhagic lesions show local hypoperfusion areas.However,3D SWAN and 3D ASL are not enough to show edema lesions,which need supplement of MR routine sequence.