Young Allen, Poretti Andrea, Bosemani Thangamadhan, Goel Reema, Huisman Thierry A G M
Division of Pediatric Radiology and Pediatric Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Charlotte R. Bloomberg Children's Center, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD, 21287-0842, USA.
Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, USA.
Neuroradiology. 2017 Aug;59(8):797-802. doi: 10.1007/s00234-017-1867-2. Epub 2017 Jun 30.
Developmental venous anomalies (DVA) are common neuroimaging abnormalities that are traditionally diagnosed by contrast-enhanced T1-weighted images as the gold standard. We aimed to evaluate the sensitivity of SWI in detecting DVA and associated cavernous malformations (CM) and microhemorrhages in children in order to determine if SWI may replace contrast-enhanced MRI sequences.
Contrast-enhanced T1-weighted images were used as diagnostic gold standard for DVA. The presence of DVA was qualitatively assessed on axial SWI and T2-weighted images by an experienced pediatric neuroradiologist. In addition, the presence of CM and microhemorrhages was evaluated on SWI and contrast-enhanced T1-weighted images.
Fifty-seven children with DVA (34 males, mean age at neuroimaging 11.2 years, range 1 month to 17.9 years) were included in this study. Forty-nine out of 57 DVA were identified on SWI (sensitivity of 86%) and 16 out of 57 DVA were detected on T2-weighted images (sensitivity of 28.1%). General anesthesia-related changes in brain hemodynamics and oxygenation were most likely responsible for the majority of SWI false negative. CM were detected in 12 patients on axial SWI, but only in six on contrast-enhanced T1-weighted images. Associated microhemorrhages could be identified in four patients on both axial SWI and contrast-enhanced T1-weighted images, although more numerous and conspicuous on SWI.
SWI can identify DVA and associated cavernous malformations and microhemorrhages with high sensitivity, obviating the need for contrast-enhanced MRI sequences.
发育性静脉异常（DVA）是常见的神经影像学异常，传统上以对比增强T1加权成像作为金标准进行诊断。我们旨在评估磁敏感加权成像（SWI）检测儿童DVA及相关海绵状畸形（CM）和微出血的敏感性，以确定SWI是否可取代对比增强MRI序列。
以对比增强T1加权成像作为DVA的诊断金标准。由一位经验丰富的儿科神经放射科医生在轴位SWI和T2加权图像上对DVA的存在进行定性评估。此外，在SWI和对比增强T1加权图像上评估CM和微出血的存在情况。
本研究纳入了57例患有DVA的儿童（34例男性，神经影像学检查时的平均年龄为11.2岁，范围为1个月至17.9岁）。57例DVA中有49例在SWI上被识别（敏感性为86%），57例DVA中有16例在T2加权图像上被检测到（敏感性为28.1%）。脑血流动力学和氧合的全身麻醉相关变化很可能是大多数SWI假阴性的原因。在轴位SWI上检测到12例患者存在CM，但在对比增强T1加权图像上仅检测到6例。在轴位SWI和对比增强T1加权图像上均能识别4例患者的相关微出血，尽管在SWI上更多且更明显。
SWI能够以高敏感性识别DVA及相关海绵状畸形和微出血，无需使用对比增强MRI序列。
