肌萎缩侧索硬化症的液体衰减翻转恢复成像研究  

FLAIR imaging study in patients with amyotrophic lateral sclerosis

作　　者：韩静[1] 马林[2] 

机构地区：[1]天津市环湖医院神经放射科,天津300060 [2]解放军总医院放射诊断科,北京100853

出　　处：《中国医学影像技术》2007年第6期788-792,共5页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金项目资助(30470512)

摘　　要：目的：探讨肌萎缩侧索硬化症（ALS）患者脑部磁共振液体衰减翻转恢复（FLAIR）T2加权像的特点及其与病程、临床评分的关系。方法：使用3．0T磁共振仪对28例临床确诊及拟诊为ALS的患者和25例年龄、性别相匹配的健康志愿者进行MRI检查。常规扫描包括横轴面T1WI、T2WI、FLAIR T2WI及冠状面FLAIR T2WI。观察ALS患者内囊后肢水平皮质脊髓束（CST）、中央前回皮层下白质（SWM）及运动皮层（PMC）的T2 FLAIR信号，并将信号按强度分级。ALS患者根据病程长短分为3组。结果：ALS组于FI，AIRT2WI观察到CST对称性的高信号（1级＋2级）的出现率为57．14％（16／28），其中明显高信号（2级）出现率为17．86％（5／28），SWM对称性高信号为85．71％（24／28），PMC黑线（MDL）为82．14％（23／28）；对照组上述改变的出现率分别为44．00％（11／25）、0．00％（0／25）、12．00％（3／25）和16．00Vo（4／25）。CST对称性的明显高信号（2级）、SWM高信号（1级＋2级）及MDL的出现率两组间有明显差别（P=0．04，P=0．00，P=0．00）。不同病程组的ALS患者其CST信号分级构成比间差异有统计学意义（χ^2=10．10，P=0．03），其中病程组2（6～20个月）的患者CST对称性高信号出现率最高（76．47％，13／17）；FLAIR T2WI中上述各种信号级别之间临床评分无明显差异（P〉O．05）。结论：ALS患者FLAIR T2WI所示CST对称性的明显高信号、SWM的高信号及MDL较为特异。CST对称性的稍高信号则无特异性。CST对称性高信号常出现在6～20个月病程的患者中。FLAIR T2WI成像中各种信号级别不能反映其临床评分的程度。Objective To study the FLAIR T2WI features in patients with amyotrophic lateral sclerosis （ALS） and its possible correlations with clinical duration and clinical scale. Methods Twenty-eight patients and 25 age and gender matched normal controls were enrolled. MRI was performed using a 3.0T MR scanner, and axial TlWI, T2WI, FLAIR T2WI, and coronal FLAIR T2WI were acquired. FLAIR T2 signals of the corticospinal tracts （CST） at the level of posterior limb of the internal capsule, subcortical white matter （SWM） in precentral cortex, and primary motor cortex （PMC） were acquired and graded by signal intensity. The patients were divided into 3 groups by the disease duration. Results Compared with those in normal subjects, ALS patients had higher incidence of hyperintense signal （grade Ⅰ ＋ Ⅱ ） on FLAIR T2WI in CST （57.14% vs 44.00%, P〉0.05） and obvious high signal （grade Ⅱ ） in CST （17.86% vs 0.00%, P〈0.05）, in SWM at precentral gyri （85.71% vs 12.00%, P〈0.01）, and in motor dark line （MDL） in PMC （82.14% vs 16.00%, P〈0.01）. CST signal changes showed differences among various disease duration groups （χ^2= 10.10, P=0.03）, and group 2 （6-20 months） had the highest incidence of hyperintensity in CST （76.47%, 13/17）. Conclusion The symmetric slight hyperin- tense signal on FLAIR T2WI in CST is less specific, but ALS is suggested when obvious T2 high signal is present. Hyperin- tense signal in SWM and MDL on FLAIR T2WI are relatively specific changes in ALS patients. Symmetric hyperintense signal in CST is most frequently seen in ALS patients during 6-20 months of disease duration, but signal grading can not reflect the clinical scale.

关 键 词：肌萎缩侧索硬化症 液体衰减翻转恢复成像 运动皮层 皮质脊髓束 

分 类 号：R593.2[医药卫生—内科学] R445.2[医药卫生—临床医学]