可复性后部脑病综合征的影像学诊断  

Imaging diagnosis of posterior reversible encephalopathy syndrome

作　　者：高波[1] 吕翠[2] 王学建[3] 马效德[4] 

机构地区：[1]贵阳医学院附属医院放射科,贵阳550004 [2]山东省莱芜市人民医院神经内科,莱芜271100 [3]贵阳医学院 [4]山东省莱芜市人民医院CT室,莱芜271100

出　　处：《中华神经医学杂志》2005年第10期1007-1010,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨可复性后部脑病综合征(PRES)的影像学表现。方法回顾性分析了12例PRES病人的临床和影像学资料,其中9例为子痫/先兆子痫,2例为高血压脑病,1例为环孢菌素A(CSA)的神经毒性。12例均行MRI检查,其中7例同时行钆喷替酸葡甲胺(Gd-DTPA)增强扫描,4例行磁共振血管造影(3D-TOFMRA)检查,1例行弥散加权成像(DWI)。7例行CT平扫检查,2例行脑血管造影(DSA)检查。结果MRI显示病灶基本上呈双侧对称性分布,多数病灶位于顶、枕叶脑实质内,T1WI呈等或略低信号,T2WI呈高信号,FLAIR像显示皮层和皮层下白质明显高信号影,较T1WI、T2WI更加清楚。注射Gd-DTPA后多无明显异常对比增强。1例DWI显示双侧顶、枕叶及额叶皮层内弥散受限呈高信号,ADC图显示邻近的皮层下白质呈高信号。4例CT显示双侧顶、枕叶及额叶对称性斑片状低密度影,3例CT未见异常。经对症处理后复查示所有病灶几乎完全吸收消失。结论PRES的影像学表现具有特征性。MRI应作为诊断本病的首选手段。Objective To investigate the imaging findings of posterior reversible encephalopatby syndrome （PRES）. Methods The clinical and imaging data of 12 patients were analyzed retrospectively： 9 cases diagnosed as pre-eclampsia/eclampsia, 2 as hypertensive encephalopathy （HE）, 1 as neurotoxicity induced by cyclosporine A （CSA）. 12 cases were examined by MRI： 7 of them with Gd-DTPA contrast enhancement study, 4 with three dimensional time of flight magnetic resonance angiography （3D-TOF MRA） and 1 with diffusion-weighted imaging （DWI）. Plain CT scan was performed in 7 patients and digital subtraction angiography （DSA） in 2 patients. Results MR/showed bilaterally symmetrical distributions of lesions, mainly located in the parieto-occipital lobes with iso-intensity or slightly low-intensity on T1WI and increased signal intensity on T2WI. FLAIR showed hyper-intensity in cortex and subcortical white matter, more clearly than T1WI and T2WI did. No apparently abnormal contrast enhancement was found after intravenous injection of Gd-DTPA. The cortex of bilateral parietal, occipital and frontal lobes in 1 case showed increased signal intensity on DWI, so was the proximal subcortical white matter on ADC map. CT studies of 4 cases demonstrated symmetric plaque-like low-attenuated lesions in bilateral parietal, occipital and frontal lobes. CT findings of other 3 cases were normal. CT or MR/for follow-up showed complete or nearly complete absorption of lesions after adequate clinical treatments. Conclusion The imaging findings of PRES are typical, so MR/should be the first choice in its diagnosis.

关 键 词：可复性后部脑病综合征 磁共振成像 体层摄影术 X线计算机 

分 类 号：R445[医药卫生—影像医学与核医学]