先兆子痫、子痫可逆性后部脑白质病并发症的MRI诊断  

MRI Diagnosis of Posterior Reversible Encephalopathy Syndrome in Eclampsia or Pre--eclampsia

作　　者：刘庆先[1] 夏爽[1] 祁吉[1] 

机构地区：[1]天津医科大学一中心临床学院放射科,天津300192

出　　处：《实用放射学杂志》2009年第5期625-627,636,共4页Journal of Practical Radiology

摘　　要：目的探讨先兆子痫、子痫的脑部并发症-可逆性后部白质脑病综合征的MRI诊断特点。方法回顾性分析14例妊娠期间或产后出现癫痫、头痛、视物模糊的先兆子痫、子痫并发PRES患者的临床及影像学资料,其中2例为顺产后3~5 d发生子痫,7例为产前先兆子痫、子痫行剖宫产术后,5例为胎死宫内伴发子痫前期重度或子痫。14例患者均行MRI检查,检查序列包括：T1WI、T2WI、FLAIR、DWI,其中12例患者还行MR静脉成像（MRV）。结果12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。14例患者MRI显示双侧顶叶（11例）、右侧顶叶（2例）、双侧枕叶（8例）、双侧额叶（7例）、右侧额叶（3例）、双侧颞叶（4例）、左侧颞枕叶交界区（1例）、胼胝体压部（1例）、双侧基底节区（2例）、右侧基底节区（1例）、左侧半卵圆中心（1例）、双侧小脑半球（1例）多发异常信号,病变主要位于双侧顶枕叶皮层下白质内,但6例患者顶枕叶皮质、1例患者颞叶皮质亦可见受累。病变于T1WI呈等或低信号,T2WI及FLAIR呈高信号,部分病灶DWI及ADC图均表现为高信号。1例患者左侧颞叶发生出血。5例随访MRI显示病灶范围、数目变小、减少、消失。结论MRI对PRES可作出明确诊断,并且以FLAIR序列显示病灶最佳。Objective To evaluate the role of MRI in diagnosis of posterior reversible encephalopathy syndrome（PRES） in eclampsia or preeclampsia. Methods The clinical and imaging data of 14 preeclampisa or eclampsia patients who were in the pregnancy or postpartum occurred epilepsy,headace and vision deficient . 2 patients were spontaneous delivery for 3-5 days and occurred eclampsia,7 patients were antepartum with preeclampsia or eclampsia ,then under with cesarean section,5 patients were dead fetus in uterus with eclampsia. All patients underwent MRI examinations, the examinations included coronal, sagittal and axial T1 WI, T2 WI, FLAIR and DWI, 12 patients also underwent MRV. Results MRV in all 12 patients showed no evidence of stenosis, dilation or thrombosis in cranial veins and sinuses. MRI in 14 patients demonstrated multiple lesions located in bilateral parietal lobe （11 cases）, right parietal lobe （2 cases）, bilateral occipital lobe （8 cases）, bilater frontal lobe （7 cases）, right frontal lobe （3 cases）, bilateral temporal lobe （4 cases） ,left tempra-occipital lobe （1 case） , splenium of corpus callosum （ 1 case）, bilatral basal ganglia （2 cases） , the right basal ganglia （1 case）, the left centrum semiovale （1 case） , bilateral cerebellar hemisphere （1 case）. The lesions were prominent within white matter, some of them involved gray matter （6 cases）, the lesions appeared as hyperintensity on FLAIR and T2 WI,isointensity or mildly hypointensity on T1 WI, hyperintensity on DWI and ADC map, which meaned vasogenic edema. 5 patient＇s follow- up scan showed decreased or disappeared abnormal signals. Conclusion MRI has advantages to display the lesions in PRES,especially the FLAIR sequence.

关 键 词：妊娠 子痫 可逆性后部脑病综合征 磁共振成像 脑 

分 类 号：R714.245[医药卫生—妇产科学] R742[医药卫生—临床医学]