成人急性播散性脑脊髓炎MRI特征分析
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摘要
目的分析成人急性播散性脑脊髓炎(ADEM)的MRI特征,提高对其认识。方法回顾性分析7例经临床确诊为ADEM成人患者的临床和MRI资料。结果病灶主要累及白质内(7例)、基底节区(3例)、丘脑(3例)、皮质(2例)、脑干(1例)、小脑(1例)、脊髓(1例)。病灶主要表现为白质内大片状、斑片状、类圆形、卵圆形异常信号,大小不一,边界不清,分布多不对称,少数也可对称,T_1WI呈低/稍低信号,T_2WI及Flair呈高信号,有4例见垂直脱髓鞘征,3例弥散轻度受限,增强扫描后1例小片状强化。结论 ADEM的MRI表现有一定的特征性,MRI具有重要的诊断价值。
Objective To explore the MRI features of acute disseminated encephalomyelitis in adult and to improve the understanding of it. Methods 7 cases of clinically proven ADEM were retrospectively reviewed. Results The lesion mainly involved white matter(7 cases), but also involved the thalamus(3 cases), basal ganglia(3 cases), brain stem(1 case), cerebellum(1 case), and spinal cord(1 case). The lesions were mainly large patchy, patchy, quasi-circular, oval-shaped abnormal signals in the white matter area, with different sizes, unclear boundaries, asymmetrical distribution, and a few symmetrical. T_1WI showed low/slightly low signal, T_2WI and Flair showed high signal. Vertical demyelination was seen in 4 cases, slight diffusion limitation in 3 cases with enhanced scan. There were 2 cases of small piece enhancement. Conclusion ADEM carries certain characteristics on MRI. MRI has greatly value in its diagnosis.
Objective To explore the MRI features of acute disseminated encephalomyelitis in adult and to improve the understanding of it. Methods 7 cases of clinically proven ADEM were retrospectively reviewed. Results The lesion mainly involved white matter(7 cases), but also involved the thalamus(3 cases), basal ganglia(3 cases), brain stem(1 case), cerebellum(1 case), and spinal cord(1 case). The lesions were mainly large patchy, patchy, quasi-circular, oval-shaped abnormal signals in the white matter area, with different sizes, unclear boundaries, asymmetrical distribution, and a few symmetrical. T_1WI showed low/slightly low signal, T_2WI and Flair showed high signal. Vertical demyelination was seen in 4 cases, slight diffusion limitation in 3 cases with enhanced scan. There were 2 cases of small piece enhancement. Conclusion ADEM carries certain characteristics on MRI. MRI has greatly value in its diagnosis.
引文
[1] Yang HQ, Zhao WC, Yang WM, et al. Clinical profiles and short-term outcomes of acute disseminated encephalomyelitis in adult chinese patients [J]. Journal of Clinical Neurology, 2016, 12(3): 282-288.
[2] Giri PP, Bhattyacharya S, Das D, et al. Acute disseminated encephalomyelitis: a clinical and neuroradiological profile of pediatric patients [J]. Neurol India, 2016, 64(6): 1187-1192.
[3] Esposito S, Di PG, Madini B, et al. A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children [J]. Autoimmunity Reviews, 2015, 14(10): 923-929.
[4] Menge T, Hemmer B, Nessler S, et al. Acute disseminated encephalomyelitis: an update [J]. Archives of Neurology, 2005, 62(11): 1673-1680.
[5] 马林, 于生元, 蔡幼铨,等. 急性播散性脑脊髓炎的脑部MRI表现[J]. 中华放射学杂志, 2000, 34(8):515-517.
[6] Zhang L, Wu A, Zhang B, et al. Comparison of deep gray matter lesions on magnetic resonance imaging among adults with acute disseminated encephalomyelitis, multiple sclerosis, and neuromyelitis optica [J]. Multiple Sclerosis, 2014, 20(4): 418-423.
[7] Berzero G, Cortese A, Ravaglia S, et al. Diagnosis and therapy of acute disseminated encephalomyelitis and its variants[J]. Expert Review of Neurotherapeutics, 2015, 16(1): 83-101.
[8] Kelly JE , Mar S, D"Angelo G, et al. Susceptibility-weighted imaging helps to discriminate pediatric multiple sclerosis from acute disseminated encephalomyelitis [J]. Pediatric Neurology, 2015, 52(1): 36-41.
[9] Otten CE, Creutzfeldt CJ. Fulminant acute disseminated encephalomyelitis presenting in an adult [J]. JAMA Neurology, 2014, 71(5): 648-649.
[10] Hartung H. ADEM Distinct disease or part of the MS spectrum?[J]. Neurology, 2001, 56(10): 1257-1260.
[11] Verhey LH , Branson HM , Shroff MM, et al. MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study [J]. Lancet Neurology, 2011, 10(12): 1065-1073.
[2] Giri PP, Bhattyacharya S, Das D, et al. Acute disseminated encephalomyelitis: a clinical and neuroradiological profile of pediatric patients [J]. Neurol India, 2016, 64(6): 1187-1192.
[3] Esposito S, Di PG, Madini B, et al. A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children [J]. Autoimmunity Reviews, 2015, 14(10): 923-929.
[4] Menge T, Hemmer B, Nessler S, et al. Acute disseminated encephalomyelitis: an update [J]. Archives of Neurology, 2005, 62(11): 1673-1680.
[5] 马林, 于生元, 蔡幼铨,等. 急性播散性脑脊髓炎的脑部MRI表现[J]. 中华放射学杂志, 2000, 34(8):515-517.
[6] Zhang L, Wu A, Zhang B, et al. Comparison of deep gray matter lesions on magnetic resonance imaging among adults with acute disseminated encephalomyelitis, multiple sclerosis, and neuromyelitis optica [J]. Multiple Sclerosis, 2014, 20(4): 418-423.
[7] Berzero G, Cortese A, Ravaglia S, et al. Diagnosis and therapy of acute disseminated encephalomyelitis and its variants[J]. Expert Review of Neurotherapeutics, 2015, 16(1): 83-101.
[8] Kelly JE , Mar S, D"Angelo G, et al. Susceptibility-weighted imaging helps to discriminate pediatric multiple sclerosis from acute disseminated encephalomyelitis [J]. Pediatric Neurology, 2015, 52(1): 36-41.
[9] Otten CE, Creutzfeldt CJ. Fulminant acute disseminated encephalomyelitis presenting in an adult [J]. JAMA Neurology, 2014, 71(5): 648-649.
[10] Hartung H. ADEM Distinct disease or part of the MS spectrum?[J]. Neurology, 2001, 56(10): 1257-1260.
[11] Verhey LH , Branson HM , Shroff MM, et al. MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study [J]. Lancet Neurology, 2011, 10(12): 1065-1073.