Bastos Leite António J, van Straaten Elisabeth C W, Scheltens Philip, Lycklama Geert, Barkhof Frederik
Department of Radiology, Vrije Universiteit Medical Center, Amsterdam, Netherlands.
Stroke. 2004 Feb;35(2):415-9. doi: 10.1161/01.STR.0000109226.67085.5A. Epub 2004 Jan 15.
The criteria of the National Institute of Neurological Disorders and Stroke (NINDS)-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) include thalamic lesions for the diagnosis of vascular dementia (VaD). Although studies concerning VaD and brain aging advocate the use of fluid-attenuated inversion recovery (FLAIR) or T2-weighted images (T2-WI) to detect ischemic lesions, none compared the sensitivity of these sequences to depict thalamic lesions.
We performed a blinded review of T2-WI and FLAIR images in 73 patients fulfilling the radiological part of the NINDS-AIREN criteria (mean age, 71 years; range, 49 to 83 years). This sample was drawn from a large multicenter trial on VaD and was expected to have a high prevalence of thalamic lesions. In a side-by-side review, including T1-weighted images as well, lesions were classified according to presumed underlying pathology.
The total number of thalamic lesions was 214. Two hundred eight (97%) were detected on T2-WI, but only 117 (55%) were detected on FLAIR (chi(2)=5.1; P<0.05). Although the mean size of lesions detected on T2-WI and not on FLAIR (4.4 mm) was significantly lower than the mean size of lesions detected on both sequences (6.7 mm) (P<0.001), 5 of the 29 lesions >10 mm on T2-WI were not visible on FLAIR. FLAIR detected only 81 (51%) of the 158 probable ischemic lesions and 30 (60%) of the 50 probable microbleeds.
FLAIR should not be used as the only T2-weighted sequence to detect thalamic lesions in patients suspected of having VaD.
美国国立神经疾病与中风研究所（NINDS）-国际神经科学研究与教育协会（AIREN）的标准将丘脑病变纳入血管性痴呆（VaD）的诊断标准。尽管有关VaD和脑老化的研究提倡使用液体衰减反转恢复（FLAIR）或T2加权成像（T2-WI）来检测缺血性病变，但尚无研究比较这些序列描绘丘脑病变的敏感性。
我们对73例符合NINDS-AIREN标准放射学部分的患者（平均年龄71岁；范围49至83岁）的T2-WI和FLAIR图像进行了盲法评估。该样本取自一项关于VaD的大型多中心试验，预计丘脑病变的患病率较高。在包括T1加权图像的并排评估中，根据推测的潜在病理对病变进行分类。
丘脑病变总数为214个。T2-WI检测到208个（97%），而FLAIR仅检测到117个（55%）（χ²=5.1；P<0.05）。尽管T2-WI检测到而FLAIR未检测到的病变平均大小（4.4mm）显著低于两个序列均检测到的病变平均大小（6.7mm）（P<0.001），但T2-WI上29个>10mm的病变中有5个在FLAIR上不可见。FLAIR仅检测到158个可能的缺血性病变中的81个（51%）和50个可能的微出血中的30个（60%）。
对于疑似患有VaD的患者，不应将FLAIR用作检测丘脑病变的唯一T2加权序列。
