低血糖脑病胼胝体压部MR扩散加权成像高信号的可逆性  

Reversibility of High Signal of the Splenium of the Corpus Callosum on MR Diffusion Weighted Imaging in Hypoglycemic Encephalopathy

作　　者：谭红艳[1] 张健[2] 刘君凤[3] 计学文 张烜赫 吴佳芮 宋博[1] 

机构地区：[1]佳木斯市中心医院MR室,黑龙江佳木斯154002 [2]佳木斯大学附属第一医院MR室,黑龙江佳木斯154002 [3]佳木斯市中心医院CT室,黑龙江佳木斯154002

出　　处：《中国医学影像学杂志》2014年第7期495-498,共4页Chinese Journal of Medical Imaging

摘　　要：目的 采用MR扩散加权成像（DWI）评价低血糖脑病（HE）患者恢复血糖前后胼胝体压部DWI高信号区表观扩散系数（ADC）的变化,探讨本病DWI征象的可逆性.资料与方法 回顾性分析临床确诊的35例HE患者,MR显示胼胝体压部DWI高信号并经及时治疗后病灶消失,记录患者的低血糖持续时间（发病至血糖恢复正常的时间）和恢复时间（血糖恢复正常至患者临床症状恢复至发病前的时间）,并分别测量首次DWI检查高信号区的ADC值,以病灶外正常白质区ADC值作为对照,计算ADC值平均降低百分比（ADC对照区-ADC病灶区/ADC对照区）.结果 35例HE患者低血糖持续时间＜24 h,恢复时间4～72 h.MR图像显示病灶均局限性位于胼胝体中线处,未累及胼胝体全部,T1WI呈等信号,T2WI呈等或稍高信号,DWI呈明显高信号、ADC值下降.病灶DWI高信号区ADC值为（0.28±0.06）×10-3 mm2/s,显著低于对照区的（0.88±0.13） ×10-3 mm2/s （P＜0.05）,ADC值平均降低（67.05±7.40）％.患者血糖恢复后胼胝体压部高信号消失、发生可逆性改变,病变区ADC值恢复正常.结论 胼胝体压部是HE可逆性损伤的最好发部位,DWI序列ADC值测量可以准确地评价HE损伤是否可逆,对临床治疗及预后判断具有重要指导意义.MR diffusion weighted imaging （DWI） is used to investigate the changes of apparent diffusion coefficient （ADC） in high signal area of the splenium of the corpus callosum on DWI before and after restoration of blood glucose in patients with hypoglycemic encephalopathy （HE）,to explore the reversibility of DWI signs of this disease.Materials and Methods Thirty-five HE patients with clinically confirmed were retrospectively analyzed,MR showed that the DWI high signal lesions in splenium of the corpus callosum disappeared after timely treatment,hypoglycemia duration （the time duration from onset to blood glucose back to normal） and their recovery time （the time duration from blood glucose returned to normal to clinical symptoms back to the state before onset） were recorded,ADC value of high signal area in the first DWI scan was also measured,with the ADC value of normal white matter outside the lesions as a control,the differences of ADC value were calculated （ADC value of control region minus ADC value of the lesion divided ADC value of control region）.Results HE duration of the 35 cases of hypoglycemia in patients was less than 24 hours,and the recovery time was 4-72 hours.MRI showed that the lesions were all localized in the midline of corpus callosum,without involving the whole corpus callosum,and appeared as equal signal in T1WI,equal or slightly high signal on T2WI,apparent high signal in DWI with declined ADC value.Focal ADC value of the high signal area in DWI was （0.28 ± 0.06）× 10-3 mm2/s,which was significantly lower than that in the control area （0.88± 0.13）× 10-3 mm2/s （P＜0.05）,and the ADC value dicreased （67.05 ± 7.40）％.The high signal area in the splenium of the corpus callosum disappeared,reversible change could be observed and the focal ADC value returned to the normal after the restoration of blood glucose level.Conclusion The splenium of the corpus callosum is the most easily affected part of reversible injury of HE,ADC value of DWI series can be used

关 键 词：脑疾病 低血糖症 胼胝体 磁共振成像 弥散 扩散加权成像 表观扩散系数 

分 类 号：R739.41[医药卫生—肿瘤] R730.42[医药卫生—临床医学]