梅毒性脑损害磁共振征象分析  

MRI Features of Syphilis Encephalopathy

作　　者：康少红[1] 高勇安[1] 王晓瑞[1] 殷敬喜[1] 

机构地区：[1]首都医科大学宣武医院放射科,100053

出　　处：《临床放射学杂志》2012年第11期1539-1542,共4页Journal of Clinical Radiology

摘　　要：目的分析梅毒脑病MRI表现,探讨其征象特点、演变规律以及在预后评估中的价值,以提高对梅毒脑病早期诊断及治疗水平。方法回顾性分析18例经临床确诊的梅毒脑病患者的MRI平扫、增强,MRA以及复查头颅MRI图像特点。结果 (1)脑萎缩13例,脑梗死8例,脑炎8例,脑膜炎改变8例,头颅MRI正常2例。(2)13例均表现为多种形式病变并存,脑萎缩为主要改变。(3)神经梅毒脑MRI病变的演变:3例行有效治疗后脑炎异常信号基本或完全吸收,后遗改变主要是脑萎缩出现或加重,2例未行正规有效治疗,脑炎病灶出现或扩大。(4)神经梅毒脑血管病变:6例MRA检查中2例局部动脉血管重度狭窄。结论 (1)梅毒脑病的基本MRI征象有脑萎缩、脑梗死、脑炎以及脑膜炎等改变;(2)不对称性脑萎缩,同时伴有脑炎和/或脑膜炎改变,具有提示梅毒脑病的意义。(3)MRI随诊能够显示梅毒脑病脑内病变的演变,特别是脑炎向脑萎缩的转变。(4)MRA可以发现梅毒所致脑内主要动脉狭窄或闭塞。Objective To analyze MRI manifestations of syphilis encephalopathy,and improve its diagnostic accuracy.Methods MRI data of 18 patients with clinical diagnosed as neurosyphilis were analyzed,including plain and enhanced MRI scan,MRA and follow up MRI.Results（1） There were 13 cases with brain atrophy;8 cases with cerebral infarction;8 cases with encephalitis,8 cases with meningitis,2 cases with normal MRI findings.（2） 13 cases were shown the coexistence for various forms of lesions,brain atrophy was the main changes.（3） After routine effective treatment,abnormal signal was absorbed partially or completely in three cases.The remain change was brain atrophy appearance,lesion expansion and new encephalitis lesion were occurred in 2 cases without effective treatment.（4） In 6 cases of MRA,2 cases had severe stenosis in horizontal segment of middle cerebral artery.Conclusion（1） MRI signs of syphilis encephalopathy include brain atrophy,cerebral infarction,encephalitis and meningitis.（2） Asymmetry of brain atrophy accompanied by cerebral infarction,encephalitis and meningitis change indicate diagnosis of syphilis encephalopathy.（3）MRI reexamination can show the evolution of the brain lesions of syphilis encephalopathy,such as encephalitis transfer to brain atrophy.（4）MR angiography can depict stenosis or occlusion of cerebral arteries.

关 键 词：神经梅毒 磁共振成像 脑损害 诊断 

分 类 号：R747.9[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]