渗透性脱髓鞘综合征的MRI特点及误诊分析  

The MRI characteristics and misdiagnosis analysis of osmotic demyelination syndrome

作　　者：代迎菊 刘影[2] DAI Yingju;LIU Ying(Department of Neurosurgery,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China;Department of Radiology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)神经外科,安徽合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)医学影像科,安徽合肥230001

出　　处：《实用放射学杂志》2022年第8期1224-1228,共5页Journal of Practical Radiology

摘　　要：目的分析渗透性脱髓鞘综合征(ODS)的MRI特点及误诊原因.方法回顾性分析6例经临床确诊ODS的MRI特点.结果6例中,病变仅位于脑桥2例,诊断为脑桥中央髓鞘溶解症(CPM);仅累及幕上2例(1例同时累及大脑皮层),诊断为脑桥外髓鞘溶解症(EPM)[1例伴脑皮质层状坏死(CLN)];同时累及幕上及幕下2例,其中1例伴皮层受累,诊断为EPM合并CPM(或伴CLN).MRI多呈T_(1)WI稍低信号、T_(2)WI稍高信号、T_(2)-液体衰减反转恢复(T_(2)-FLAIR)高信号、扩散加权成像(DWI)早期明显高信号、部分伴强化,呈对称性分布,脑桥病变多误诊为脑梗死;幕上病变难以确诊,误诊为其他代谢性疾病或感染性病变.结论ODS可累及脑桥内、外,桥内病灶MRI有一定特征性,呈"蝙蝠翅样"、"猪鼻样"、"猫头鹰样"等形态,桥外病灶MRI缺乏特异性,需综合分析.误诊主要与病因复杂、认识不足、影像学表现延迟等因素相关.ObjectiveTo analyze the MRI characteristics and misdiagnosis causes of osmotic demyelination symdrome(ODS).Methods The MRI characteristics of 6 clinically confirmed ODS patients were analyzed retrospectively.Results Of the 6 cases,2 cases located only in the pons were diagnosed with central pontine myelinolysis(CPM);2 cases were involved supratentorial areas(1 case involved the cerebral cortex),including 1 case with extrapontine myelinolysis(EPM)and 1 case with cortical laminar necrosis(CLN);2 cases were involved both supratentorial and subtentorial areas,and 1 case with cortical involvement was diagnosed as EPM with CPM(or with CLN).Lesions with symmetric distribution located in brain mostly presented slightly low signal on the T_(1)WI,slightly high signal on the T_(2)WI,high signal on T-fluid attenuated inversion recovery(T_(2)-FLAIR),obviously high signal on early diffusion weighted imaging(DWI),enhancements in some cases.Pontine lesions were mostly misdiagnosed as cerebral infarction,and supratentorial lesions were difficult to be clearly diagnosed and mostly misdiagnosed as other metabolic diseases or infectious diseases.Conclusion ODS can be involved in the intrapontine and extrapontine,Intrapontine lesions show certain MRI characteristics,including"bat-wing-like","pig-nose-like"and"owl-like",while extrapontine lesions lack MRI characteristies with comprehensive analysis on ODS diagnosis.Misdiagnosis is mainly related to the complicated etiology,insuffcient understanding and delayed imaging performances.

关 键 词：渗透性 髓鞘溶解 磁共振成像 

分 类 号：R741[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]