MRI诊断异基因造血干细胞移植后神经系统并发症  

MRI diagnosis of central nervous system complications after allogeneic-hematopoietic stem cell transplantation

作　　者：蒋孟茜 赖云耀[1] 王煦[1] 贾晓璇 洪楠[1] JIANG Mengxi;LAI Yunyao;WANG Xu;JIA Xiaoxuan;HONG Nan(Department of Radiology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院放射科,北京100044

出　　处：《中国医学影像技术》2018年第9期1342-1346,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨异基因造血干细胞移植后中枢神经系统并发症的类型及其MRI表现。方法回顾性分析22例异基因造血干细胞移植后中枢神经系统并发症患者的临床及影像学资料,分析其并发症类型及相应MRI表现。结果颅内感染8例,包括真菌感染5例,颅内单发或多发结节状异常信号伴环形强化;病毒感染3例,为多发斑片状T2WI及FLAIR高信号。移植后淋巴细胞增殖性疾病1例,右侧额叶出血性占位伴不均匀强化。脑血管病6例,包括硬膜下出血2例,表现为单侧或双侧硬膜下新月状T1WI、T2WI混杂信号;脑梗死4例,表现为单发或多发片状T1WI低信号、T2WI高信号,DWI呈高信号。可逆性后部脑病综合征5例,MRI示双侧顶枕叶为主的皮层下FLAIR高信号。中枢神经系统白血病2例,其中软脑膜浸润1例,软脑膜呈FLAIR稍高信号,增强后明显强化;脑实质浸润1例,左侧小脑斑片状T1WI等信号、T2WI稍高信号,增强后明显强化。结论异基因造血干细胞移植后中枢神经系统并发症类型多样;MRI对早期诊断、及时治疗及评估疗效有重要价值。Objective To investigate the types and MRI findings of central nervous system(CNS)complications after allogeneic-hematopoietic stem cell transplantation(allo-HSCT).Methods Clinical and MRI data of 22 patients with CNS complications after allo-HSCT were analyzed retrospectively.The types and MRI findings of CNS complications were observed.Results CNS infections were observed in 8 patients,including fungal infection in 5 patients,MRI showed single or multiple nodules with rim enhancement,and virus infection in 3 patients,while MRI showed hyperintensity of multiple lesions on T2WI and FLAIR.Post-transplant lymphoproliferative disease was observed in 1 patient,while MRI showed heterogeneously enhancing mass with hemorrhage in the right frontal lobe.Cerebrovascular diseases were found in 6 patients,including subdural hemorrhage in 2 patients,MRI showed unilateral or bilateral subdural crescent-shaped mixed signal on T1WI and T2WI,and cerebral infarction in 4 patients,MRI showed single or multiple slices low signal on T1WI,high signal on T2WI and DWI.Posterior reversible encephalopathy syndromes were found in 5 patients,with hyperintensity of bilateral parieto-occipital subcortical on FLAIR imagings.Central nervous system leukemia was detected in 2 patients,including 1 case of meningeal infiltration,while MR showed slightly high signal of cerebral pia mater on FLAIR images,and increased significantly after enhancement.One case of parenchymal infiltration,presented as left cerebellar patchy equal signal on T1WI,slightly high signal on T2WI,whereas increased significantly after enhancement.Conclusion The types of CNS complications after allo-HSCT are various.MRI is of great value for early diagnosis,timely treatment and evaluation of therapeutic effect for these patients.

关 键 词：异基因造血干细胞移植 并发症 中枢神经系统疾病 磁共振成像 

分 类 号：R733.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]