可逆性后部脑病综合征影像学与临床预后的关系  

Association of radiologic findings with clinical prognosis in posterior reversible encephalopathy syndrome

作　　者：高波[1] 吕翠[2] 刘奉立[1] 梁辉[2] 

机构地区：[1]山东烟台毓璜顶医院影像科,山东烟台264000 [2]山东省烟台市烟台山医院神经内科,山东烟台264001

出　　处：《医学影像学杂志》2012年第10期1627-1631,共5页Journal of Medical Imaging

基　　金：烟台市科学技术发展计划项目(编号:2008142-4)

摘　　要：目的研究可逆性后部脑病综合征(PRES)不典型影像学表现与临床预后的关系,进一步提高对其发病机制的认识。方法回顾性分析了2007年7月～2011年12月烟台毓璜顶医院有完整临床、影像学资料的70例PRES患者,收集患者血压、病因、实验室检查、影像学资料、随访情况,由2位有经验的神经放射医生共同评价影像学异常、水肿程度及分级评定。结果病变分布模式与临床病因之间无明显相关性;出现细胞毒性水肿(20/70)、脑出血(19/70)、异常强化(10/17)与脑水肿的较高分级均具有相关性(rs=0.75、0.61、0.65,P﹤0.05),后两者也具有相关性(rs=0.71,P﹤0.05);三者与血压均无相关性(P>0.05)。结论弥散受限、脑出血及异常强化反映了血管内皮细胞的损伤或破坏,认识PRES的不典型表现对其早期诊断和预后评价具有重要价值。Objective To investigate the relationships between atypical radiologic findings in posterior reversible enceph alopathy syndrome （PRES） and clinical outcome. Methods Seventy patients with typical clinical symptoms and characteristic MR imaging findings of PRES were included in this study. The clinical records including of blood pressure, cuase were collected in all patients. The extent or degree of brain edema was graded by 2 observers blinded to patients＇ clinical record, as well as the atypical findings determined based on other scanning protocols. Results No correlation was found between lesions distribution patterns and clinical causes. Cytotoxic edema （20/70）, intracranial hemorrhage （19/70）, ab normal enhancement （10/17） were not correlated with blood pressures （ P 〉0.05） but all correlated with higher edema scores （ rs 0.75, 0.61, 0.65, P 〈 0.05）, the latter two of the three radiologic findings were also correlative （ rs = 0.71, P 〈 0.05）. Conclusion The atypical neuroimaging appearances, such as cytotoxic edema, intracranial hemorrhage and abnormal enhancement, reflect endothelial injury or disruption, which would be helpful for early diagnosis and prognosis evaluation.

关 键 词：后部白质脑病综合征 脑水肿 高血压 磁共振成像 预后 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]