氨己烯酸治疗婴儿痉挛症颅脑MRI异常表现及分析  

Analysis of brain MRI abnormalities in infantile spasms treated with vigabatrin

作　　者：符念霞 宋建勋[2] 向超 李晨曦[1] 段祺 郭啸林 矫秉轩 边祥兵[1] 娄昕[1] 吕晋浩 FU Nianxia;SONG Jianxun;XIANG Chao;LI Chenxi;DUAN Qi;GUO Xiaolin;JIAO Bingxuan;BIAN Xiangbing;LOU Xin;LÜJinhao(Department of Radiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,Shenzhen Baoan People's Hospital,Shenzhen 518101,China;Department of Radiology,Ethnic and Chinese Medicine Hospital of Xiangxi Autonomous Prefecture,Jishou 416000,China)

机构地区：[1]解放军总医院第一医学中心放射诊断科,北京100853 [2]深圳市宝安区人民医院MR室,深圳518101 [3]湘西土家族苗族自治州民族中医院放射科,吉首416000

出　　处：《磁共振成像》2025年第1期104-110,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金项目(编号:82271952);国家重点研发计划项目(编号:2022YFC2410005)。

摘　　要：目的总结氨己烯酸(vigabatrin,VGB)治疗婴儿痉挛症过程中相关颅脑MRI异常的特点。材料与方法回顾性分析2019年7月至2023年5月就诊于解放军总医院第一医学中心,口服VGB治疗并出现颅脑影像学改变的婴儿痉挛症患儿,分析其基线影像学特点及随访影像学特点。结果共收集32例婴儿痉挛症患儿,年龄(10.34±0.86)个月。颅脑MRI表现:21例累及双侧丘脑、脑干(背侧)、苍白球、小脑齿状核,呈对称性分布;9例累及双侧海马,1例累及单侧海马,1例累及双侧壳核及尾状核头。各序列对病变的检出率为:磁共振扩散加权成像(diffusion weighted imaging,DWI)序列100.0%,表观扩散系数(apparent diffusion coefficient,ADC)序列50.0%,T2WI序列46.9%,T2液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)序列25.0%,T1WI序列25.0%。经过回归分析结果显示,典型与不典型VGB相关头颅MRI异常(vigabatrin-associated brain abnormalities on MRI,VABAM)的表现与性别、年龄、病因、VGB峰值剂量、MRI检查时VGB剂量、新发临床症状等多种临床因素无关,P值分别为0.888、0.924、0.955、0.360、0.058、0.636。10例患儿随访时1例原异常信号完全消失,5例减轻,1例变化不大,3例异常信号较前明显。发现MRI异常时,2例新出现锥体外系为主的症状,停药后患儿临床症状消失。结论颅脑MRI丘脑、脑干(背侧)、苍白球、小脑齿状核的对称性DWI异常信号可出现在VGB治疗婴儿痉挛症过程中,部分可累及海马,多为可逆性的。DWI对病变的检出率高。Objective:To summarize the MRI features of brain abnormalities associated with the use of vigabatrin(VGB)in the treatment of infantile spasms.Materials and Methods:To retrospectively analyze the baseline imaging characteristics and follow-up imaging characteristics of children with infantile spasticity who admitted in the First Medical Center of the Chinese People's Liberation Army(PLA)and were treated with VGB and presented with cephalometric imaging changes from July 2019 to May 2023.Results:A total of 32 children with infantile spasticity were collected,with a mean age of(10.34±0.86)months.Cerebral MRI showed that 21 cases involved bilateral thalamus,brainstem(dorsal),basal ganglia(pallidum),and dentate nucleus of the cerebellum in a symmetrical distribution.Nine cases involved bilateral hippocampus,one case involved unilateral hippocampus,and one case involved bilateral shell nuclei and head of caudate nucleus.The positive detection rates of lesions were 100.0%in diffusion weighted imaging(DWI)sequence,50.0%in apparent diffusion coefficient(ADC)sequence,46.9%in T2 sequence,25.0%in fluid attenuated inversion recovery(FLAIR)sequence and 25.0%in T1 sequence.After regression analysis,the results showed that the presentation of typical versus atypical VGB-associated brain abnormalities on MRI(VABAM)was independent of a variety of clinical factors,such as gender,age,etiology,peak VGB dose,VGB dosage during MRI examinations,and new onset of symptoms.The corresponding P values for these factors were 0.888,0.924,0.955,0.360,0.058,and 0.636.At the follow-up of 10 children,1 case of the original abnormal signal completely disappeared,5 cases were reduced,1 case had little change,and 3 cases of the abnormal signals were more obvious than before.At the time of detection of MRI abnormalities,two cases had new extrapyramidal predominant symptoms,and the children's clinical symptoms disappeared after discontinuation of the drug.Conclusions:Symmetrical DWI abnormal signals in the thalamus,brainstem(dorsal),pallidum,and cereb

关 键 词：氨己烯酸 婴儿痉挛症 磁共振成像 不良反应 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742.1[医药卫生—诊断学]