妊娠相关性脑静脉及静脉窦血栓形成和可逆性后部白质脑病的磁共振鉴别  

Application of MRI in the differentiation of pregnancy-related cerebral venous sinus thrombosis and reversible posterior leukoencephalopathy syndrome

作　　者：刘子凡[1] 许治强[1] 匡永锋[1] 关海涛[1] 陈敦金[2] 

机构地区：[1]广州医学院第三附属医院神经内科,510150 [2]广州医学院第三附属医院妇产科广州市重症孕产妇救治中心,510150

出　　处：《中国神经免疫学和神经病学杂志》2011年第6期420-424,423-424,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨MRI和MRV在妊娠相关性脑静脉及静脉窦血栓形成(CVST)和可逆性后部白质脑病综合征(RPLS)鉴别诊断中的价值。方法回顾性分析3例妊娠相关性CVST和6例重度子痫前期、子痫发生RPLS患者的影像学资料。所有患者均行MRI和DSA检查,其中7例患者行MRV检查。结果 3例CVST患者中,1例孤立性大脑上静脉前组血栓形成,MRI表现为相应部位T1WI低、等信号,T2WI、FLAIR等、稍高信号,DWI为等、高信号,ADC图为低、稍高信号;2例横窦血栓形成,表现为双侧枕叶皮质、皮质下白质片状T1WI低信号,T2WI、FLAIR高信号,DWI、ADC高信号,可不对称性地累及顶叶、小脑半球,MRV与DSA检查结果相符。6例RPLS患者MRI显示双侧顶、枕叶皮质、皮质下白质多发性、斑片状、对称性病变,部分严重患者大脑半球呈弥漫性、大片状受累,表现为T1WI低信号,T2WI、FLAIR高信号,DWI、ADC高信号;1例患者MRV检查示左侧横窦未显影,DSA检查示左侧横窦通畅。结论横窦血栓形成和RPLS患者MRI均显示血管源性脑水肿,两者脑水肿主要发生于双侧枕、顶叶,但前者范围较局限,后者范围更广泛,可累及基底节、额叶、颞叶。RPLS患者MRV检查可有假阳性,DSA是鉴别两者的重要检查方法。Objective To assess the value of MRI and MRV in the differentiation of pregnancy-related cerebral venous sinus thrombosis （CVST） and reversible posterior leukoeneephalopathy syndrome （RPLS）. Methods The medical imaging data of 3 pregnancy related CVST patients and 6 RPLS patients due to severe preeclampsia or eclampsia were analyzed and compared retrospectively. All the patients performed MRI and DSA and 7 had MRV. Results Of the 3 CVST patients, 1 developed isolated thrombosis in the front group of superior cerebral vein. MRI showed hypointensity or isointensity on T1WI, isointensity or slight hyperintensity on T2WI and FLAIR, isointensity or hyperintensity on DWI, and hypointensity or slight hyperintensity on ADC. The other 2 patients developed transverse sinus thrombosis. MRI showed abnormal signals in bilateral occipital cortex and subcortieal white matter, which were hypointensity on T1WI, hyperintensity on T2WI and FI.AIR, and hyperintensity on DWI and ADC. The parietal lobes and cerebellum could be implicated asymmetrically. MRV findings were concordant with DSA. MRI of the 6 RPLS patients showed multiple symmetrical patches in bilateral parietal and occipital cortex and subcortical white matter. In some severe cases, diffuse and large patches were found in the cerebral hemisphere, which were hypointense on T1WI, hyperintense on T2WI and FLAIR, and hyperintense on DWI and ADC. In 1 patient, left transverse sinus was unvisualized by MRV, which was proved to be unobstructed by DSA. Conclusions MRI findings of the patients with transverse sinus thrombosis and RPI.S all showed vasogenic brain edema, which was mainly observed in the bilateral occipital lobes and parietal lobes. While patients with transverse sinus thrombosis had limited brain edema, patients with RPLS had more extensive brain edema, which could involve the basal ganglia, frontal lobes and temporal lobes. MRV findings of the patients with RPLS may give false-positive results, and DSA is important in differentiating transverse sinus throm

关 键 词：妊娠 窦血栓形成 颅内 后部白质脑病综合征 磁共振成像 

分 类 号：R747.9[医药卫生—神经病学与精神病学]