甲氨蝶呤诱发儿童急性脑病的 MRI 及临床表现特征分析  

Methotrexate-induced acute encephalopathy in children：MRI findings and clinical features

作　　者：李航[1] 彭芸[1] 段晓岷[1] 漆佩静[2] 段彦龙[2] 

机构地区：[1]首都医科大学附属北京儿童医院影像中心磁共振成像设备与技术北京市重点实验室,100045 [2]首都医科大学附属北京儿童医院血液病中心,100045

出　　处：《中华放射学杂志》2014年第5期418-421,共4页Chinese Journal of Radiology

基　　金：国家自然科学基金面上项目（31271161）;北京市卫生系统高层次卫生技术人才培养项目（2011-3-054）;北京科技重大专项项目（2011ZX09302-007-01）

摘　　要：目的：分析甲氨蝶呤（ MTX）所致儿童急性脑病MRI及临床表现的特点。方法回顾性分析13例经临床确诊的MTX急性脑病的临床和影像资料。总结MRI表现特点，包括病灶位置、信号特征及MRI随访变化。结果13例患儿中，全身抽搐2例。言语不利5例，其中合并单侧偏瘫4例，合并右侧面瘫1例。单侧肢体无力5例。左侧偏瘫1例。10例病灶位于半卵圆中心和（或）脑室旁白质，表现为非对称性边界清楚DWI高信号， ADC图低信号。1例为双额、顶、枕皮层及皮层下片状长T2信号，DWI少许高信号。 MRI复查10例DWI异常信号全部吸收，8例于原DWI异常信号部位出现FLAIR高信号，5例范围较前减小，1例范围增大，2例范围无明显变化。1例额、顶、枕皮层及皮层下长T2信号范围减小，DWI异常信号消失。结论甲氨蝶呤所致急性脑病以卒中样发作为典型临床表现。 DWI是诊断本病最敏感的影像学检查方法，深部白质非对称性DWI异常信号为特征性改变。 MTX所致细胞毒性水肿为短暂且可逆过程。Objective To evaluate the MRI findings and clinical features of methotrexate-induced acute encephalopathy in children.Methods The clinical data and brain MRI obtained in 13 children with methotrexate-induced acute encephalopathy were retrospectively reviewed.The MRI features were analyzed , including information on the location , the signal intensity and follow-up MRI study was performed.Results Of the 13 patients , 2 patients suffered from seizure.Five patients had dysphasia , of which 4 patients had evidence of hemiparesis , 1 patient had right facial palsy.Five patients had unilateral weakness.And left hemiparesis was observed in 1 patient.DWI revealed well demarcated asymmetrical hyperintensity lesions within the centrum semiovale and/or periventricular white matter in 10 patients, corresponding to areas of hypointensity on ADC maps.One case showed hyperintensity areas in the bilateral supratentorial cortex and subcortical white matter on T 2-weighted images with subtle high-intensity on DWI.In all 10 cases there were resolution of the diffusion abnormality , 8 cases displayed residual FLAIR signal abnormalities involving areas of previously seen diffusion restriction , 5 cases showed decreased range of the lesion , 1 case was progressive, and 2 cases were stable.One case with hyperintensity areas in the supratentorial cortex and subcortical white matter showed small residual hyperintensity on T 2-weighted images and resolution of the diffusion abnormality.Conclusions MTX-induced acute encephalopathy often manifests as stoke-like symptoms.DWI is the imaging modality of choice for the detection of acute MTX neurotoxicity , and asymmetrical restricted diffusion in the deep white matter is the characteristic sign.Cytotoxic edema induced by MTX is transient and reversible .

关 键 词：甲氨蝶呤 磁共振成像 脑 

分 类 号：R733.71[医药卫生—肿瘤] R445.2[医药卫生—临床医学]