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目的探讨 CT、MRI 在诊断脑后部可逆性脑病综合征(PRES)中的价值。方法 8例女性 PRES 患者中6例为孕妇,1例肺癌手术后化疗患者,1例高血压患者,均行 MR 静脉成像(MRV)、T_1WI、T_2WI、水抑制序列(FLAIR)成像及扩散加权成像(DWI);其中2例行 CT 平扫,5例行增强 MRI 及三维增强 MR 血管成像(3D CEMRA)。结果 CT 示病灶呈低密度,边界不清。8例患者MRV 显示脑静脉、静脉窦通畅,无狭窄、异常扩张及血栓形成征象。MRI 显示双侧顶枕叶(8例)、基底节区(2例)、额叶(4例)多发异常信号,主要位于双侧顶枕叶皮质下白质内,3例患者皮质亦受累。在 T_1WI 病灶呈等或略低信号,T_2WI 及 FLAIR 呈高信号,以 FLAIR 像显示皮质病变为佳。DWI 显示大部分病灶呈等信号,表观扩散系数(ADC)图呈等或高信号。部分病灶 DWI 及 ADC 图均表现为高信号。随访 MRI 显示所有患者病灶范围、数目逐渐变小、减少。5例行增强扫描患者显示病灶呈轻度强化,3D CEMRA 显示强化沿双侧大脑前动脉、大脑中动脉及大脑后动脉终末支分布,部分呈“葡萄状”。随访增强扫描显示病灶强化范围及程度逐渐缩小、消失。结论 FRES 好发于顶枕叶白质,但也可见于基底节、额叶及脑皮质。病变为血管源性水肿,增强 T_1 WI 及3D CEMRA 显示病灶有可逆性强化。以 MR FLAIR 及 T_2WI 序列显示病灶最佳。
Objective To investigate the value of CT and MRI in the diagnosis of reversible encephalopathy syndrome (PRES). Methods Six of 6 women with PRES were pregnant women, one patient undergoing chemotherapy after lung cancer surgery and one patient with hypertensive disease underwent MR venography (MRV), T 1WI, T 2WI, water suppression sequence (FLAIR) imaging and diffusion weighted imaging (DWI); 2 cases underwent CT scan, 5 cases underwent enhanced MRI and 3D enhanced MR angiography (3D CEMRA). CT showed lesions showed low density, the border is unclear. MRV in 8 patients showed cerebral venous sinus, sinus patency, no stenosis, abnormal expansion and thrombosis signs. MRI showed multiple occipital lobes (n = 8), basal ganglia (n = 2), and frontal lobes (n = 4) with multiple abnormal signals, mainly in the bilateral superior occipital lobe cortical white matter and in 3 patients with cortical involvement. T_1WI lesions showed equal or slightly lower signal, T_2WI and FLAIR showed high signal to FLAIR images showed cortical lesions better. DWI showed that most lesions showed equal signal and apparent diffusion coefficient (ADC) showed equal or high signal. Some lesions DWI and ADC showed high signal. Follow-up MRI showed that the range of lesions in all patients, the number becomes smaller and smaller. Five patients underwent enhanced scan showed mild enhancement of the lesion, and 3D CEMRA showed enhancement of the terminal branch of the anterior cerebral artery, middle cerebral artery and posterior cerebral artery, with “grape-like” part. Follow-up enhanced scan showed lesion enhancement range and extent gradually reduced and disappeared. Conclusion FRES occurs predominantly in the occipital lobe white matter, but also in the basal ganglia, frontal cortex and cerebral cortex. Lesions were vasogenic edema, enhanced T 1 WI and 3D CEMRA showed focal reversible enhancement. MR FLAIR and T_2WI sequence showed the best lesions.