磁共振成像对孕产妇可逆性后部脑病综合征预后的诊断价值  

The Value of MR Imaging in Evaluation of Prognosis in Pregnant and Postpartum Women with Reversible Posterior Leukoencephalopathy Syndrome

作　　者：祁英[1] 王晓明[1] 潘诗农[1] 郭启勇[1] 

机构地区：[1]中国医科大学附属盛京医院放射科,辽宁沈阳110004

出　　处：《实用放射学杂志》2010年第11期1554-1556,1564,共4页Journal of Practical Radiology

基　　金：辽宁省教育厅重点实验室资助项目（20060918）.

摘　　要：目的 评价磁共振成像（MRI）对孕产妇可逆性后部脑病综合征（reversible posterior leukoencephalopathy syndrome,RPLS）预后的诊断价值.方法 收集临床确定为RPLS孕产妇7 例的MR资料.总结临床预后与患者早期病灶在T1WI、T2WI、DWI上的特征、分布、演变的关系.结果 7 例患者中仅1 例预后较差,问话不答、意识不清仍存在,其早期MRI示双侧额、顶、颞、枕叶皮层及白质、小脑、脑干、基底节大片状稍长T1稍长T2信号影,DWI仅示右侧基底节斑片状高信号,余大部分病灶未见显示,MRA、MRV均未见脑血管异常,复查MRI示病变仍存在.其余6 例预后较佳,视物不清、头痛、抽搐症状明显好转,其中5 例早期MRI示双侧顶叶、枕叶斑点片状稍长T1稍长T2信号影,DWI均未见病灶显示.5 例MRA、MRV均未见脑血管异常.1 例早期MRI仅示胼胝体压部斑片状稍长T1稍长T2信号影,DWI呈高信号,MRA示双侧大脑前动脉共干,MRV未见异常.结论 RPLS多累及顶、枕叶,一般预后较佳.大部分病灶DWI上呈低信号,提示RPLS是血管源性水肿.Objective To assess the value of magnetic resonance imaging （MRI） in evaluation of prognosis in pregnant and post- partum women with the reversible posterior leukoencephalopathy syndrome （RPLS）. Methods Seven cases of RPLS confirmed by MRI examinations and clinical symptoms were included in the study. All cases underwent conventional MRI and DWI during the per- inatal and follow--up period. The relationship between the clinical prognosis and the appearance, distribution and evolution of the le- sions on T1 WI,Tz WI and DWI was assessed. Results Among 7 patients, 1 patient with a poor prognosis was unconsciousness and unanswered. The lesions appeared as slight hypo-intensity on T1 WI and hyper--intensity on T2 WI,on DWI the lesion showed hyperintensity in the right basal ganglia ,but the others showed no abnormality, and there was no abnormality on MRA and MRV. 6 patients had good prognosis. Clinical symptoms disappeared. In 5 patients, the lesions appeared as hypo--intensity on TIWI and hy- per--intensity on T2 WI in parietal and occipital lobes. There was no abnormality on DWI, MRA and MRV. In 1 patient, the lesions appeared as hypo-- intensity on T1 WI and hyper-- intensity on Tz WI in splenium of the corpus callosum, and hyperintensity on DWI. MRA showed common arterial trunk of bilateral anterior cerebral arteries,MRV was normal. Conclusion The lesions of RPLS often located in parietal and occipital lobes with a good prognosis. Most lesions appeared as hypo--intensity on DWI,which suggests RPLS is associated with vasogenic edema.

关 键 词：脑 可逆性后部脑病综合征 妊娠 磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学] R714.1[医药卫生—临床医学]