摘要
目的探讨磁共振成像(MRI)在诊断后循环可恢复性脑病综合征(PRES)中的应用价值。方法收集2015年10月至2017年2月天津中医药大学第一附属医院及天津医科大学总医院收治的PRES患者24例为研究对象,分析24例患者的MRI资料,其中16例经积极治疗后复查。结果所有患者病灶均累及双侧顶枕叶交界区,其中6例同时合并双侧额叶对称性受累,4例同时合并双侧小脑半球对称性受累。MRI扫描表现为稍长T1、稍长T2信号,弥散加权成像(DWI)序列上,24例患者受累皮质均表现为高信号,但其中21例受累皮质的表观弥散系数(ADC)值低于正常皮质[(0.87±0.11)×10-3mm2/s比(1.10±0.83)×10-3mm2/s](P<0.01),另外3例受累皮质的ADC值与正常皮质无明显差别,出现ADC值"假正常化"。随访16例患者积极治疗后复查MRI,所有病灶于各个序列均消失。结论 PRES好发于顶枕叶,MRI T2加权成像、DWI和ADC显示病灶较佳。PRES经早期积极治疗预后良好,但如果延误诊断和治疗,则会造成不可逆的神经系统后遗症。
Objective To evaluate diagnostic value of magnetic resonance imaging （MRI） for posterior reversible encephalopathy syndrome （PRES） and to learn the pathophysiologic mechanisms of PRES. Methods Altogether 24 patients diagnosed with PRES admitted to the First Teaching Hospital of Tianjin University of TCM and General Hospital of Tianjin Medical University from Oct. 2015 to Feb. 2017 were included in the study, 16 of them were rechecked after active treatment. Results Lesions of PRES of all the patients were located in bilateral parieto-occipital lobes, and six cases with bilateral frontal lobes involved,four eases with bilateral cerebellar hemisphere involved. Lesions appeared as isointense or mildly hypointense signals on Tl-weighted images and T2-weighted images, hyperintenes on DWI, and in all patients but three,the lesions appeared as hypointese apparent diffusion coefficient（ADC） values[ （0.87 ± 0. 11 ） ×10-3 mm2/s vs （ 1.10±0.83） × 10-3 mm2/s] （P 〈0.01 ）. And the cortex ADC values of the three patients were as the same as the nor- real cortex,which was called ＂ false normalization＂. In the 16 followed-up patients, MRI indicated abnormalities resolved after appropriate treatment. Conclusion Lesions of PRES are usually located in parieto-occipital lobes, T 2-weighted ima- ges, DWI and ADC images have advantages to display lesions of PRES. Although PRES is reversible when treatment is instituted, delayed diagnosis and therapy can cause chronic neurological sequelae.
出处
《医学综述》
2017年第22期4566-4570,共5页
Medical Recapitulate
关键词
后循环可恢复性脑病综合征
表观弥散系数值假正常化
血管源性水肿
磁共振成像
Posterior reversible encephalopathy syndrome
Pseudonormalized appearance diffusion coefficient value
Vasogenic edema
Magnetic resonance imaging
