脑干出血后肥大性下橄榄核变性的磁共振成像分析  

The magnetic resonance imaging analysis of hypertrophic olivary degeneration after brainstem hemorrhage

作　　者：占鸣 丁忠祥[3] 张梅花 徐亦生 高智琴 杨路 Zhan Ming

机构地区：[1]浙江中医药大学,310053 [2]浙江萧山医院,311202 [3]杭州市第一人民医院,311000 [4]杭州市第九人民医院,311215 [5]杭州市萧山区中医院,311201 [6]杭州明州脑康复医院,311215

出　　处：《浙江临床医学》2022年第3期336-339,共4页Zhejiang Clinical Medical Journal

基　　金：杭州市卫生科技计划项目(B20200234);杭州市萧山区科技局项目(2020318)。

摘　　要：目的探讨脑干出血所致肥大性下橄榄核变性(HOD)的磁共振常规和扩散张量成像的影像学表现及病理学机制。方法回顾性收集16例脑干出血后继发性的HOD患者(HOD组)和16名性别、年龄、受教育程度相匹配的正常志愿者(对照组)的磁共振成像资料,分析脑干出血的磁共振表现,肥大性下橄榄核变性的影像学表现,测量变性的下橄榄核的径线、局部的FA值、并追踪脑20条纤维束,结合文献对其相应影像学表现的病理学机制进行分析。结果1例表现为左侧下橄榄核变性,其余均为双侧下橄榄变性,肥大下橄榄核的左右径和前后径均大于正常人(P<0.05),T_(2)WI呈稍高信号,FLAIR呈稍高信号,T_(1)WI呈等信号,DWI呈等信号。HOD组脑桥的FA值明显小于对照组(P<0.05);HOD组下橄榄核的FA值与对照组差异无统计学意义。HOD组右侧丘脑辐射、皮质脊髓束、右侧扣带海马体、右侧钩束、右侧弓状束和左侧丘脑辐射、左侧下额枕束、左侧下纵束的FA值小于对照组(P<0.05)。结论脑干出血所致的HOD有其特定的影像学表现和病理学机制,磁共振检查可为临床诊断和治疗HOD提供无创、客观的依据。Objective To investigate the imaging manifestations and pathological mechanisms of the routine and diffusion tensor imaging of hypertrophic olivary degenerarion(HOD)induced by brain stem hemorrhage.Methods MR imaging of 16 HOD patients(HOD group)and 16 normal volunteers(control group)matched with gender,age and education level were collected retrospectively.The MR findings of brainstem hemorrhage and hypertrophic olivary degeneration were analyzed.The diameter line and local FA value of the degenerated inferior olivary nucleus were measured,and 20 brain fiber tracts were tracked.The pathological mechanism of corresponding imaging manifestations was analyzed in combination with literature.Results One case presented left inferior olivary degeneration,and the rest were bilateral inferior olivary degeneration.The left-right diameter and anterior-posterior diameter of the hypertrophic olivary nucleus were larger than those of normal subjects(P<0.05).The signal of HOD was slightly hyperintensity on T_(2)WI and FLAIR,isointensity on T_(1)WI and DWI.The FA value of pons in HOD group was significantly lower than that in normal control group(P<0.05).The FA value of olivary nucleus in HOD group was not significantly different from that in normal control group.The FA values of radiation from the right thalamus,corticospinal tract,right cingulate hippocampus,right uncinate tract,right arcoid tract and left thalamus,left inferior frontooccipital tract and left inferior longitudinal tract in the HOD group were lower than those of the control group(P<0.05).Conclusion HOD caused by brain stem hemorrhage has its own imaging features and pathological mechanism.MR imaging can provide noninvasive and objective basis for clinical diagnosis and treatment of HOD.

关 键 词：脑干 肥大性下橄榄核变性 磁共振成像 弥散张量成像 

分 类 号：R74[医药卫生—神经病学与精神病学]