脑淀粉样血管病相关炎症的MRI表现分析  

Preliminary study of MRI features of cerebral amyloid angiopathy-related inflammation

作　　者：陈佳 陈杰[2] 付强[3] 刘庆 张艳 谢婕 丁国恒 王学建 Chen Jia;Chen Jie;Fu Qiang;Liu Qing;Zhang Yan;Xie Jie;Ding Guoheng;Wang Xuejian(Department of Radiology,the Affiliated Guizhou Aviation Industry Cor Ltd No 300 Hospital of Zunyi Medical University,Guiyang 550009,China;Department of Radiology,Xingyi People′s Hospital,Xingyi 562400,China;Department of Radiology,Anshun People′s Hospital,Anshun 561000,China;Department of Neurology,the Affiliated Guizhou Aviation Industry Cor Ltd No 300 Hospital of Zunyi Medical University,Guiyang 550009,China)

机构地区：[1]遵义医科大学附属贵航三〇〇医院影像科,贵阳550009 [2]贵州省兴义市人民医院影像科,562400 [3]贵州省安顺市人民医院影像科,561000 [4]遵义医科大学附属贵航三〇〇医院神经内科,贵阳550009

出　　处：《中华放射学杂志》2021年第6期627-632,共6页Chinese Journal of Radiology

摘　　要：目的:探讨脑淀粉样血管病相关炎症(CAA-ri)的MRI特征。方法:回顾性分析2013年6月至2020年6月在遵义医科大学附属贵航三〇〇医院(9例)、兴义市人民医院(2例)及安顺市人民医院(1例)就诊,并诊断为很可能和可能CAA-ri患者12例的临床及影像学资料。12例患者中女3例、男9例,年龄57~89(71±10)岁。诊断为很可能CAA-ri 5例、可能CAA-ri 7例。病程30 min~2年,1例接受基因检测为过表达ApoEε4/ε4基因。12例均接受头颅MR检查(包括12例磁敏感加权成像、10例DWI、9例增强MR、3例MRS,7例MRA、1例磁共振灌注成像)。结果:CAA-ri的影像表现包括脑病样表现、瘤样表现及经典脑淀粉样血管病(CAA)表现。12例呈脑病样表现,T_(2)加权液体衰减反转恢复序列(FLAIR)见累及U形纤维的斑片状白质高信号(WMH),多不对称,不同程度占位效应,DWI无扩散受限,无强化。1例瘤样表现呈单发的肉芽肿样病变,增强后不规则强化;经典CAA表现为出血性病变(微出血灶8例、脑叶出血6例、蛛网膜下腔出血3例、脑表面铁沉积7例)及缺血性病变(微梗死灶1例、扩大的血管周间隙与脑叶腔隙4例)。5例复查可见病变吸收好转及新发病灶。结论:CAA-ri的影像特征主要为T_(2)FLAIR上累及U形纤维的斑片状WMH,多不对称,具游走性,此起彼伏,临床与影像不相称。Objective To explore the MRI features of cerebral amyloid angiopathy-related inflammation(CAA-ri).Methods The clinical and imaging data of 12 patients with CAA-ri diagnosed in Affiliated Guizhou Aviation Industry Cor Ltd No 300 Hospital of Zunyi Medical University(9 cases),Xingyi People′s Hospital(2 cases)and Anshun people′s Hospital(1 case)from June 2013 to June 2020 were analyzed retrospectively.There were 3 females and 9 males,aged from 57 to 89 years old,with an average age of 71±10 years.The twelve patients included 5 cases with probable CAA-ri and 7 cases with possible CAA-ri.The duration of the disease ranged from 30 minutes to 2 years.One patient has ApoEε4/ε4 gene overexpressed.All the 12 patients underwent MRI,including susceptibility weighted imaging in 12 cases,DWI in 10 cases,contrast enhanced MRI(CE-MRI)in 9 cases,MRS in 3 cases,MRA in 7 cases,and perfusion-weighted imaging in 1 case.Results Imaging features of CAA-ri included encephalopathic,tumoral,classical cerebral amyloid angiopathy(CAA)manifestations.Twelve cases of encephalopathic manifestations showed patchy white matter hyperintensity(WMH)involving U-shaped fibers on T2 weighted fluid-attenuated inversion recovery sequence(FLAIR),usually asymmetric,with various degree of mass effect,no diffusion restriction on DWI and no enhancement on CE-MRI.One case showed a single tumoral lesion with irregular enhancement on CE-MRI.The classic CAA findings included hemorrhagic lesions(microhemorrhage in 8 cases,lobar hemorrhage in 6 cases,subarachnoid hemorrhage in 3 cases,iron deposition on the brain surface in 7 cases)and ischemic lesions(microinfarction in 1 case,enlarged perivascular space and interlobar space in 4 cases).Follow-up showed lesions absorption and/or new lesion formation in 5 cases.Conclusions The MRI features of CAA-ri are mainly patchy WMH involving U-shaped fibers on T2 FLAIR,usually asymmetric,with wandering and alternating features,and inconsistency with clinical manifestations.

关 键 词：脑淀粉样血管病 并发症 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]