艾滋病进行性多灶性脑白质病的影像学表现及分期  

Imaging findings and staging of progressive multifocal leukoencephalopathy in acquired immunodeficiency syndrome patients

作　　者：李航[1,2] 龚晓明 鲁植艳 Li Hang;Gong Xiaoming;Lu Zhiyan(Department of Imaging,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;the Department of Radiology,Stomatology Hospital of Wuhan University,Wuhan 430079,China)

机构地区：[1]武汉大学中南医院影像科,430071 [2]武汉大学口腔医院放射科,430079

出　　处：《中华放射学杂志》2020年第8期759-762,共4页Chinese Journal of Radiology

基　　金：北京市医院管理局重点医学专业发展计划(ZYLX201511)。

摘　　要：目的探讨艾滋病患者进行性多灶性脑白质病(PML)的典型MRI特点及各期影像学表现,为临床诊断、评估和分期提供依据。方法回顾性分析2016年1月至2018年4月在武汉大学中南医院住院11例艾滋病合并PML的患者的临床及MRI资料,其中5例行多次MRI检查,共计25次MRI检查。重点观察病灶的分布、形态、信号特征,对比多次MRI检查中病变的变化,并对25次MRI结果进行影像分期。结果典型MRI表现为双侧大脑不对称的多灶性脑白质病变,顶额叶最常见,呈扇形T1高信号,T2低信号,液体衰减反转恢复序列高信号,无明显占位效应,增强扫描一般不强化。进展期多灶性脑白质病变扩大融合呈大片状,并逐渐累及深部脑白质,部分可合并深部脑灰质及小脑病变。病变内出现坏死而信号不均。周围新发病变呈明显扩散受限,表现为不完整的扩散加权成像高信号环,相应表观扩散系数值减低。晚期病变以坏死为主,周围伴局灶性脑萎缩。结论PML具有一定特征性的MRI表现及各期影像学特点,MRI可以帮助临床进行诊断、评估和分期。Objective To investigate the MRI features of progressive multifocal leukoencephalopathy(PML)in acquired immunodeficiency syndrome(AIDS)patients,and to provide evidence for clinical diagnosis,evaluation and staging.Methods Form Janurary 2016 to April 2018,11 AIDS patients with clinical diagnosis of PML were enrolled at Zhongnan Hospital of Wuhan University.A total of 25 MRI examination data of 11 patients(5 patients underwent multiple examinations)were reviewed.The distribution,morphology and signal characteristics of the lesions were analyzed,and the changes of the lesions between multiple MRI examinations were compared.The lesions of all 25 MR images were staged according to MR features.Results Typical image findings of PML included confluent,bilateral but asymmetric distributed,supratentorial white matter abnormal signal lesions.The parietal lobe was most commonly involved,followed by the frontal lobe.The lesions often showed hypointensity on T1 and hyperintensity on T2 weighted images.No obvious mass effect or enhancement was found.In advanced stage,multifocal white matter lesions were enlarged in size and more confluent,displaying large patchy abnormal signal intensity,with gradually involving the deep white matter,and occasionally combing with gray matter and cerebellar lesions.The disease showed heterogenous signal intensity due to necrosis in the lesion.The newly appeared lesions showed obvious diffusion restriction,demonstrating high signal intensity on diffusion weighted imaing with low apparent diffusion coefficient value.The main finding of the later stage was necrosis,with focal asymmetric brain atrophy was observed.Conclusions PML in AIDS patients has characteristic MRI findings,and MRI features varies in different stages.MRI can be helpful in clinical diagnosis,evaluation and staging of PML.

关 键 词：脑白质病 进行性多灶性 获得性免疫缺陷综合征 磁共振成像 诊断 分期 

分 类 号：R512.91[医药卫生—内科学] R445.2[医药卫生—临床医学]