可逆性后部脑病综合征的临床特点及影像学诊断价值
|
摘要
目的探讨可逆性后部脑病综合征(PRES)的临床特点及影像学特征,以期提高对该病的诊断水平。方法分析16例PRES患者临床及影像资料。结果 12例表现为急性起病,4例表现为亚急性起病。发病时血压均有不同程度升高。病灶以双侧顶枕叶白质水肿为主,颞叶、额叶、小脑半球、基底节、脑干及胼胝体也可见病灶。CT平扫病灶表现为脑白质多发片状低密度影,较小及皮层病灶难以显示。MRI平扫病灶表现为T1WI呈稍低信号,T2WI及FLAIR序列呈高信号。DWI序列及ADC图多数呈等或稍高信号,少数病灶内可见点状低信号。6例行MRI增强扫描病灶均未见强化,4例行MRV检查未见异常。结论 PRES是可逆性病变,早期诊断及时治疗是脑组织可逆的关键。MRI是诊断本病的重要检查方法,正确认识影像学特征结合临床表现,对早期诊断有重要意义。
Objective To investigate the clinical and imaging features of posterior reversible encephalopathy syndrome( PRES),in order to improve the level diagnostic. Methods The clinical and radiologic date of 16 PRES patients were analyzed retrospectively. Results 12 cases of patients with acute onset and 4 cases of patients with sub-acute onset. The blood pressure increased in varying degrees during the onset of the disease. The lesions mainly located in the white matter of bilateral parieto-occipital lobe. Lesions were also seen in the bilateral temporal lobe,frontal lobe,brainstem,cerebellum and corpus callosum. The lesions in white matter showed multiple low density area on CT images. Small and cortical lesions difficult to display on CT. MRI findings showed that,the lesions were demonstrated as slightly fewhypointensitive on T1 WI and hyperintensitive on T2 WI or FLAIR. Most lesions showed isointensity or slightly hyperintensitive and slightly hypointensitive in a few lesions on DWI and ADC maps. 6 cases enhancement scanning without enhancement and 4 cases MRV without obvious abnormality. Conclusions PRES is reversible,early diagnosis and timely treatment is the key to reversible brain tissues. MRI is an important method for the diagnosis of this disease. Combining imaging features with clinical manifestations are of great significance for early diagnosis.
Objective To investigate the clinical and imaging features of posterior reversible encephalopathy syndrome( PRES),in order to improve the level diagnostic. Methods The clinical and radiologic date of 16 PRES patients were analyzed retrospectively. Results 12 cases of patients with acute onset and 4 cases of patients with sub-acute onset. The blood pressure increased in varying degrees during the onset of the disease. The lesions mainly located in the white matter of bilateral parieto-occipital lobe. Lesions were also seen in the bilateral temporal lobe,frontal lobe,brainstem,cerebellum and corpus callosum. The lesions in white matter showed multiple low density area on CT images. Small and cortical lesions difficult to display on CT. MRI findings showed that,the lesions were demonstrated as slightly fewhypointensitive on T1 WI and hyperintensitive on T2 WI or FLAIR. Most lesions showed isointensity or slightly hyperintensitive and slightly hypointensitive in a few lesions on DWI and ADC maps. 6 cases enhancement scanning without enhancement and 4 cases MRV without obvious abnormality. Conclusions PRES is reversible,early diagnosis and timely treatment is the key to reversible brain tissues. MRI is an important method for the diagnosis of this disease. Combining imaging features with clinical manifestations are of great significance for early diagnosis.
引文
[1] Hinchey J,Chaves C,Appignani B,et al. A reversible posterior leukoencephalopathy syndromev[J]. N Engl J Med,1996,334(9):494-500.
[2] Casey SO,Sampaio RC,Michel E,et al. Posterior reversible encephalopathy Syndrome:utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical andsubeortieal lesions[J]. AJNR Am J Neuroradiol,2000,21(13):1199-1206.
[3] EI Karoui K,Le Quintrec M,Dekeyse E,et al. Posterior reversible encephalopathy syndrome in systemic lupus erythematosus[J]. Nephrol Dial Transplant,2008,23(2):757-763.
[4] Sinha R,Hurley RM. Posterior reversible encephalopathy syndrome in SLE nephritis[J]. Postgrad Med J,2008,84(987):56
[5]张敏,石敏,刘效辉.妊娠并发可逆性后部脑病综合征临床分析(附3例报告)[J].山东医药,2011,51(46):56-57.
[6]王光彬,单瑞芹,赵斌.脑后部可逆性脑病综合征的CT,MRI诊断[J].中华放射学杂志,2006,40(9):908.
[7]宋海乔,黄丽娜,强军,等.脑后部可逆性脑病综合征MRI及DWI表现及临床意义[J].中国实用神经疾病杂志,2015,18(3):73.
[8]李治群,高金鸟,涂蓉.妊娠期高血压疾病合并可逆性后部脑病综合征的影像特征[J].放射学实践,2014,29(8):909-913.
[9]陈雷,吕超群,段雪艳,等.可逆性后部脑病综合征的MRI影像特点及发病机制的探讨[J].实用临床医学,2013,14(9):88-90,140.
[10] Garg R K.. Posterior leukoencephalopathy syndrome[J].. Postgrad Med J,2001,77(903):24.
[11] Mckinuey AM,Sarikaya B,Gustafson C,et al. Detection of mirco-hemorrhage in posterior reversible encephalopathy syn drome using susceptibility weighted imaging[J]. Am J Neuroradiol,2012,33(5):896-903.
[12] Schwartz RB. Mulkem RV,Gudbjartsson H,et al. Diffusion-weighted MR imaging in hypertensive encephalopathy:clues to pathogenesis[J]. AJNR,1998,19(9):85.
[2] Casey SO,Sampaio RC,Michel E,et al. Posterior reversible encephalopathy Syndrome:utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical andsubeortieal lesions[J]. AJNR Am J Neuroradiol,2000,21(13):1199-1206.
[3] EI Karoui K,Le Quintrec M,Dekeyse E,et al. Posterior reversible encephalopathy syndrome in systemic lupus erythematosus[J]. Nephrol Dial Transplant,2008,23(2):757-763.
[4] Sinha R,Hurley RM. Posterior reversible encephalopathy syndrome in SLE nephritis[J]. Postgrad Med J,2008,84(987):56
[5]张敏,石敏,刘效辉.妊娠并发可逆性后部脑病综合征临床分析(附3例报告)[J].山东医药,2011,51(46):56-57.
[6]王光彬,单瑞芹,赵斌.脑后部可逆性脑病综合征的CT,MRI诊断[J].中华放射学杂志,2006,40(9):908.
[7]宋海乔,黄丽娜,强军,等.脑后部可逆性脑病综合征MRI及DWI表现及临床意义[J].中国实用神经疾病杂志,2015,18(3):73.
[8]李治群,高金鸟,涂蓉.妊娠期高血压疾病合并可逆性后部脑病综合征的影像特征[J].放射学实践,2014,29(8):909-913.
[9]陈雷,吕超群,段雪艳,等.可逆性后部脑病综合征的MRI影像特点及发病机制的探讨[J].实用临床医学,2013,14(9):88-90,140.
[10] Garg R K.. Posterior leukoencephalopathy syndrome[J].. Postgrad Med J,2001,77(903):24.
[11] Mckinuey AM,Sarikaya B,Gustafson C,et al. Detection of mirco-hemorrhage in posterior reversible encephalopathy syn drome using susceptibility weighted imaging[J]. Am J Neuroradiol,2012,33(5):896-903.
[12] Schwartz RB. Mulkem RV,Gudbjartsson H,et al. Diffusion-weighted MR imaging in hypertensive encephalopathy:clues to pathogenesis[J]. AJNR,1998,19(9):85.