可逆性后部脑病综合征的CT及MRI表现  

CT and MRI manifestations of posterior reversible encephalopathy syndrome

作　　者：翁淑萍[1] 李跃明[2] 庞万良[1] 方如旗[1] 

机构地区：[1]福建省妇幼保健院影像科,福建福州350001 [2]福建医科大学附属第一医院影像科,福建福州350005

出　　处：《中国医学影像技术》2010年第11期2037-2040,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨可逆性后部脑病综合征(PRES)的CT和MRI表现。方法回顾性分析12例PRES患者的临床和影像学资料,所有患者均接受MR平扫,包括常规T2W、T1W、FLAIR序列扫描、DWI,4例接受磁共振静脉血流成像(MRV),3例接受MR增强扫描;3例接受CT扫描。9例治疗后复查MRI。对病灶分布部位及受累几率的比较采用四格表Fisher确切概率法。结果 12例患者均有突发性血压升高病史,其中子痫前期10例,高血压病2例。病灶主要累及双侧顶枕叶白质区,与基底节区、颞叶、额叶、脑干、小脑和胼胝体受累几率比较差异均有统计学意义(P均<0.05)。病变CT表现为白质区多发斑片状低密度,MRI呈对称性长T1长T2信号,FLAIR呈高信号,DWI等信号,ADC图呈高信号10例,ADC等信号2例。临床治疗1～2周后9例复查MRI示脑白质区病灶可完全恢复,基底节疗效常不佳。结论 PRES的MRI典型征象是双侧顶枕叶白质区多发对称性血管源性水肿,FLAIR序列和T2WI是显示病灶的最佳序列,DWI和MRV有鉴别意义。Objective To investigate the CT and MRI features of posterior reversible encephalopathy syndrome（PRES）.Methods Clinical and imaging data of 12 patients with PRES were analyzed retrospectively.MR examination was performed on all the patients including T2W,T1W,FLAIR sequence and DW images.Four patients underwent magnetic resonance venography（MRV）,and 3 received contrast enhanced MR scan.Three patients underwent CT scan.Follow-up MR examination was performed in 9 patients.Fisher exact probability test was used to analyze the distribution and involved probability of lesions.Results All the patients presented with suddenly rise of blood pressure,10 had secondary to preeclampsia,and 2 had primary hypertension.The lesions mainly located in the white matter of bilateral parieto-occipital lobes.There were statistical differences of the involved probability of the lesions in the white matter compared with basal ganglia,frontal lobe,brainstem,cerebellum and corpus callosum（all P0.05）.The lesions in white matter showed multiple patchy hypodensity on CT images,and appeared as symmetrical long T1 and long T2 signal on MRI,hyperintense signal on FLAIR,isointense signal on DWI and hyperintensity（n=10）or isointensity（n=2）on apparent diffusion coefficient（ADC）maps.Nine patients received MR scan 1—2 weeks after treatment,all the lesions in white matter resolved totally,but those in basal ganglia,they usually presented poor-prognosis.Conclusion Imaging characteristics of PRES are multiple symmetrical vasogenic brain edema in the white matter of bilateral parieto-occipital lobes.FLAIR and T2WI have advantages to display the lesions of PRES.DWI and MRV are helpful to differential diagnosis.

关 键 词：可逆性后部脑病综合征 磁共振成像 体层摄影术 X线计算机 

分 类 号：R445.2[医药卫生—影像医学与核医学] R814.42[医药卫生—诊断学]