瘤样炎性脱髓鞘病的磁共振成像与氢质子磁共振波谱特征及其临床应用价值  

Characteristics and clinical value of MRI/1H-magnetic resonance spectroscopy in tumor-like inflammatory demyelinating diseases

作　　者：黄艳[1] 马秀华[1] 肖智博[2] 薛鹏[1] 张斯佳[1] 陈勇[1] 张琼[1] 

机构地区：[1]郑州人民医院医学影像科,450003 [2]重庆医科大学附属第一医院放射科,400042

出　　处：《中华神经科杂志》2014年第10期687-690,共4页Chinese Journal of Neurology

摘　　要：目的 分析瘤样炎性脱髓鞘病（TIDD）的磁共振成像/氢质子磁共振波谱（MRI/1HMRS）特征,探讨MRI/1H-MRS对TIDD的临床应用价值.方法 回顾性分析10例经病理证实的脑TIDD的MRI征象,并与病理进行对照.结果 病变主要位于脑白质,占位效应较轻.MRI平扫均呈T1低T2高信号,DWI 7例呈明显高信号,3例呈稍高或高低混杂信号.MRI增强：5例明显强化呈“开环征”,4例斑片状或结节样明显强化,1例片状或线状轻度强化.3例内缘显示扩张血管影,垂直于侧脑室壁.4例1H-MRS均表现为乳酸和脂质明显升高;3例出现谷氨酸和谷氨酰胺的复合物β,γ-谷氨酸复合物峰升高,N-乙酰天冬氨酸均不同程度降低,胆碱升高.病理表现为病变区髓鞘脱失,炎细胞浸润伴反应性星形胶质细胞增生、肥大及异常核分裂象,7例见具有核分裂的肥胖型胶质细胞.结论 TIDD的MRI征象有其突出特点：水肿明显占位效应轻,MRI增强可见“开环征”及扩张小静脉,肿块呈低灌注,1 H-MRS出现明显升高β,γ-谷氨酸复合物峰,乳酸和脂质峰明显升高,N-乙酰天冬氨酸轻度减低,胆碱轻度升高,综合分析MRI及1H-MRS典型特征,结合临床表现,有助诊断.Objective To summarize the magnetic resonance imaging/ 1 H-magnetic resonance spectroscopy （MRI/1 H-MRS） features of tumor-like inflammatory demyelinating diseases （TIDD）,and investigate the clinical value of MRI/1 H-MRS.Methods MRI features of 10 cases of TIDD in brain confirmed by pathology were retrospectively analyzed and compared with pathology.Results The lesions mainly located in the white matter with mild mass effect.MRI scan all showed low T1 high T2 signal,and 7 cases showed high signal,3 cases showed slightly high or mixed signals on DWI.Enhanced MRI showed 5 cases with significant enhancement with ＂ open loop＂ sign,4 cases with significant patchy or nodular enhancement,1 case with mild flakes or linear enhancement.Three cases showed expanded blood vessels and plumbed to the lateral wall inside the edge of the lesions.1H-MRS performance showed 4 cases all with significantly increased Lac and Lip; 3 cases with rised glutamate and glutamine complex β,γ-Glx peaks,reduced N-acetylaspartate acid （NAA）,increased Cho to varying degrees.All pathological changes were demyelination,perivascular inflammatory infiltration and reactive gliosis,hypertrophy and abnormal mitotic figure.Seven cases could be seen obesity glial cells.Conclusions TIDD had its salient MRI features：lesion had obvious edema and mild mass effect,MRI enhancement showed ＂open loop＂ sign and small veins expansed,on perfusion-weighted imaging it showed low perfusion.1H-MRS showed β,γ-Glx peaks,Lac and Lip peaks significantly increased,NAA slightly reduced,Cho mildly elevated.Comprehensively analyzing the MRI and 1H-MRS features,combined with clinical manifestations,contribute to the diagnosis of the disease.

关 键 词：脱髓鞘疾病 磁共振成像 磁共振波谱学 

分 类 号：R744.5[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]