渗透性髓鞘溶解综合征MRI表现  

MRI manifestations of osmotic demyelination syndrome

作　　者：赵海峰 吕秀花 周永怀 焦飞涵 张天敏 ZHAO Hai-feng;LYU Xiu-hua;ZHOU Yong-huai;JIAO Fei-han;ZHANG Tian-min(Magnetic Resonance Room,the Affiliated Hospital of Gansu Medical College,Pingliang 744000,Gansu Province,China;Department of Radiology,the first Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]甘肃医学院附属医院磁共振室,甘肃平凉744000 [2]空军军医大学第一附属医院放射科,西安710032

出　　处：《医疗卫生装备》2021年第1期57-60,65,共5页Chinese Medical Equipment Journal

摘　　要：目的:探讨渗透性髓鞘溶解综合征[包括脑桥中央髓鞘溶解症(central pontine myelinosis,CPM)和脑桥外髓鞘溶解症(extra pontine myelinolysis,EPM)]的MRI表现,旨在提高对该病的认识。方法:回顾性分析某院2014—2019年经临床及影像确诊的14例渗透性髓鞘溶解综合征患者的病历资料,所有患者均行MRI检查(均行T1WI、T2WI、FLAIR序列扫描,其中8例行DWI序列扫描),观察并记录各病例在MRI平扫序列上异常信号发生的部位并总结其信号特点以及在DWI序列上的信号特点。结果:MRI均表现为T1WI低信号、T2WI高信号、FLAIR高信号。14例患者中CPM5例,CPM合并EPM 9例。CPM表现为脑桥类圆形、类三角形病灶,其中3例表现为"三叉戟征",1例表现为"猪鼻征";9例EPM病灶,表现为尾状核及壳核对称性受累6例,丘脑对称分布的点状病灶3例。8例患者中DWI弥散受限5例,表现为中央低、边缘高信号1例,阴性2例。结论:MRI是诊断和后续随访渗透性髓鞘溶解综合征的首选成像方法,对于临床高度怀疑渗透性髓鞘溶解综合征的患者,MRI能够更早、更准确地明确诊断,对临床早期干预和治疗具有较大的指导价值。Objective To enhance the understanding of osmotic demyelination syndrome including central pontine myelinosis(CPM)and extra pontine myelinolysis(EPM)by investigating its MRI manifestations.Methods Totally 14 patients with infiltrative myelinolysis syndrome diagnosed by clinical and imaging examinations in some hospital from 2014 to 2019 had their medical records analyzed retrospectively,and underwent MRI of T1 WI,T2 WI and FLAIR,of whom,eight ones went through MRI scan of DWI sequence.Each patient had the sites of the abnormal signals in MRI scan sequences observed and recorded,and had the signal characteristics in MRI scan sequences and DWI sequence summarized.Results MRI showed hypointensities on T1 WI and hyperintensities on T2 WI and FLAIR.There were 5 cases of CPM and 9 cases of CPM combined with EPM.The CPM patients had the manifestations of round and triangular-like lesions in pons,including 3 cases with trident sign and 1 case with pig nose sign;EPM showed symmetrical involvement of caudate nucleus and putamen in 6 cases,and symmetrical distribution of punctate lesions in thalamus in 3 cases;of the 8 patients,5 ones had limited diffusion on DWI,one case had hypointensity in the center while hyperintensity at the margin and two ones had negative results.Conclusion MRI is preferred for the diagnosis and subsequent follow-up of osmotic demyelination syndrome.For the patient suspected highly with osmotic demyelination syndrome MRI contributes to its early and accurate diagnosis,and is of value for guiding its early intervention and treatment.[Chinese Medical Equipment Journal,2021,42(1):57-60,65]

关 键 词：渗透性髓鞘溶解综合征 脑桥中央髓鞘溶解症 脑桥外髓鞘溶解症 磁共振成像 弥散加权成像 

分 类 号：R318[医药卫生—生物医学工程] R445.2[医药卫生—基础医学]