脑皮质层状坏死的影像学观察与分析  

Radiological observation and analysis of cortical laminar necrosis

作　　者：王朝晖[1] 赵金勇[1] WANG Zhaohui;ZHAO Jinyong(Department of Radiology,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010,P.R.China)

机构地区：[1]首都医科大学附属北京中医医院放射科,北京100010

出　　处：《医学影像学杂志》2020年第6期934-937,共4页Journal of Medical Imaging

摘　　要：目的探讨脑皮质层状坏死(CLN)影像学特征,以提高对其的认识,并对其机制进行分析和推测。方法回顾性分析2011年3月~2019年3月间经影像学检查发现22例CLN患者的MRI和CT图像,观察CLN分布范围、信号或密度随时间变化的特点并结合文献对其机制进行分析。结果本组CLN全部出现在脑梗死后;发病部位:主要发生在大脑中动脉供血区和后皮质分水岭区,21例累及多个脑叶;5例在33个月内病变范围扩大或出现新病灶。MRI表现:沿大脑皮质分布的脑回样T1WI高信号于脑梗死后最早约2周出现,3例病灶异常信号前期由弱逐渐变强;1例脑梗死5个月后信号减弱,未见消失;同期T2WI呈脑回样高或等信号,T2-FLAIR呈高信号。CT表现:5例可见沿脑皮质分布的脑回样高密度,CT值46~107HU,脑梗死后最早3周出现,2例密度逐渐增高,未见密度减低。结论CLN的影像学诊断具有重要价值;CLN的特征性信号和密度不符合出血,而符合蛋白结合水效应和钙化灶的影像学表现。Objective To improve the understanding and to speculate the mechanism of CLN by studying the imaging characteristics of CLN.Methods MR and CT images of 22 patients with CLN detected by radiological examination from March 2011 to March 2019 were retrospectively analyzed,and the characteristics of CLN distribution,the changing with time of CLN range,signal or density were observed,and the mechanism was analyzed based on literature.Results All CLN appeared after cerebral infarction.Location mainly occurred in the blood supply area of the middle cerebral artery and the watershed area of the posterior cortex,involving multiple cerebral lobes in 21 cases;In 5 patients,the lesion was enlarged or new lesion appeared within 33 months.MRI showed the high intensity of T 1WI distributed along cerebral cortex with gyrus form appeared at the earliest about 2 weeks after the ictus of cerebral infarction,and the abnormal signal in 3 cases gradually increased from weak to strong at the early stage.In one case,the signal was weakened and did not disappear after 5 months.T 2WI showed gyri hyperintensity or isointensity,T 2-flair hyperintensity.As for CT,five cases showed high density of Gyrus shape along cerebral cortex,CT value was 46~107 HU,the earliest one appeared 3 weeks after the ictus of cerebral infarction,density increased gradually in 2 cases,but no density decreased.Conclusion The imaging diagnosis of CLN has important value.The characteristic signal and density of CLN are not consistent with hemorrhage,but with imaging findings of protein binding water effect and calcification foci.

关 键 词：脑皮质层状坏死 磁共振成像 钙化 脑梗死 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]