横纹肌溶解症的临床与MRI表现分析
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摘要
目的探讨横纹肌溶解症(rhabdomyolysis,RM)MRI表现特点。方法回顾性分析经临床、实验室确诊的横纹肌溶解症患者10例MRI表现。对病变的部位、范围、形态、信号及周围组织改变等进行分析。结果 10例中外伤后6例,服用过量药物后1例,持续高烧5天后1例,食用海豚后1例,食用小龙虾后1例。10例均有肌肉酸痛、肌无力、浓茶色尿、肌酸激酶和尿肌红蛋白升高,其中合并消化道出血5例,弥漫性血管内凝血5例,肝功能不全5例,急性肾功能衰竭2例。10例中病变位于两侧大、小腿2例,右侧上臂2例,左侧上臂、右腰部及两侧大腿1例,两侧臀部及腰背部1例,两侧大腿1例,两侧小腿1例,左侧大腿1例,两侧腹壁1例。10例MRI显示受累的肌肉组织均有不均匀异常信号,界限不清,其中伴肌间轻中度渗出和皮下水肿8例。MRI信号在T1WI上呈均匀稍低信号4例,均匀等信号3例,不均匀稍高信号影3例。T2WI和T2WI脂肪抑制序列上均呈斑片状、絮状及小条片状不均匀高信号影,病变松散、范围广。结论横纹肌溶解MRI征象结合临床和实验室检查可明确诊断。
Objective To investigate the MRI characteristics of rhabdomyolysis and their clinical value. Methods The MRI findings of 10 patients with rhabdomyolysis confirmed by the clinic and laboratory data were analyzed retrospectively. The location,extent,shape,signal or density of the lesion and the surrounding tissue were analyzed. Results Of those 10 cases,6 were resulted from post-trauma,1 from drug overdose( n = 1),1 from the high fever last for 5 days,1 from eating the dolphins,1 from eating crayfish. All of those 10 cases had muscle pain,muscle weakness,dark brown urine,and the increase in blood creatine kinase and blood myoglobin,of whom 5 presented with gastrointestinal bleeding,5 with diffuse intravascular coagulation,5 with liver failure,and 5 with acute kidney functional failure. In the 10 cases,the lesion was located on both sides of the thigh and the calf in 2 cases each,on the right side of the upper arm in 2 cases each,on the left side of the upper arm and right flank and both sides of the hips in 1 case each,on the both sides of the glutes and shaft sma in 1 case,on the both sides of the thigh in 1 case,on both sides of the thigh in 1 case,on both sides of the calf in 1 case,on the left thigh in 1 case,and on the both sides of the rectus in 1 case. In 10 patients,MRI showed that the affected muscle groups had uneven abnormal signals and the boundaries were unclear,of whom 8 cases presented with intermuscular muscle with mild and moderate exudation and subcutaneous edema.MRI showed iso-or hypo-intense signal on T1 WI in 4 cases,iso-or homogeneous signal in3 cases,and inhomogeneous or slightly higher signal in 3 cases. The T1 WI had a slightly lower signal,uniform and other signals. The fat suppression sequences on T2 WI and T2 WI appeared patches,floccus,and/or small pieces of uneven high signals and the lesions were loose and wide. Conclusion MRI findings of rhabdomyolysis syndrome combined with clinical and laboratory tests can confirm the diagnosis.
Objective To investigate the MRI characteristics of rhabdomyolysis and their clinical value. Methods The MRI findings of 10 patients with rhabdomyolysis confirmed by the clinic and laboratory data were analyzed retrospectively. The location,extent,shape,signal or density of the lesion and the surrounding tissue were analyzed. Results Of those 10 cases,6 were resulted from post-trauma,1 from drug overdose( n = 1),1 from the high fever last for 5 days,1 from eating the dolphins,1 from eating crayfish. All of those 10 cases had muscle pain,muscle weakness,dark brown urine,and the increase in blood creatine kinase and blood myoglobin,of whom 5 presented with gastrointestinal bleeding,5 with diffuse intravascular coagulation,5 with liver failure,and 5 with acute kidney functional failure. In the 10 cases,the lesion was located on both sides of the thigh and the calf in 2 cases each,on the right side of the upper arm in 2 cases each,on the left side of the upper arm and right flank and both sides of the hips in 1 case each,on the both sides of the glutes and shaft sma in 1 case,on the both sides of the thigh in 1 case,on both sides of the thigh in 1 case,on both sides of the calf in 1 case,on the left thigh in 1 case,and on the both sides of the rectus in 1 case. In 10 patients,MRI showed that the affected muscle groups had uneven abnormal signals and the boundaries were unclear,of whom 8 cases presented with intermuscular muscle with mild and moderate exudation and subcutaneous edema.MRI showed iso-or hypo-intense signal on T1 WI in 4 cases,iso-or homogeneous signal in3 cases,and inhomogeneous or slightly higher signal in 3 cases. The T1 WI had a slightly lower signal,uniform and other signals. The fat suppression sequences on T2 WI and T2 WI appeared patches,floccus,and/or small pieces of uneven high signals and the lesions were loose and wide. Conclusion MRI findings of rhabdomyolysis syndrome combined with clinical and laboratory tests can confirm the diagnosis.
引文
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[11]贺发贵,李鑫宇,何志军,等.运动性横纹肌溶解致急性肾损伤22例病理特点与临床分析[J].中国中西医结合肾病杂志,2015,16(10):907-908.
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[13]唐吉刚,王树才,曹霞,等.劳力性热射病致横纹肌溶解症八例临床病理分析[J].中华神经科杂志,2013,46(7):454-457.
[14]许凡勇,夏进东,何瑶,等.皮肌炎并横纹肌溶解症CT及MRI表现一例[J].临床放射学杂志,2016,35(6):896-898.
[15]Mian AZ,Saito N,Sakai O.Rhabdomyolysis of the head and neck:computed tomography and magnetic resonance imaging findings[J].Dentomaxillofac Radiol,2011,40(6):390-392.
[2]Gigante A,Giraldi GD,Gasperini ML,et al.Rhabdomyolysis after midazolam administration in a cirrhotic patient treated with atorvastatin[J].World J Gastrointest Pharmacol Ther,2014,5(3):196-199.
[3]王丽晖,吴广礼,张丽霞,等.运动性横纹肌溶解症27例临床诊断及治疗[J].华北国防医药,2004,16(4):272-273.
[4]蔡建芳,曲璇,李航,等.非外伤性横纹肌溶解症39例临床分析[J].中国实用内科杂志,2008,28(10):847-849.
[5]李峥艳,邹翎,宋彬,等.地震挤压伤致下肢横纹肌溶解症的MRI表现[J].中华放射学杂志,2008,42(11):1126-1128.
[6]徐晓榕,何红权.剧烈运动致横纹肌溶解症并肌红蛋白尿二例[J].中国基层医药,2012,19(19):3039-3040.
[7]张磊,谢院生,陈香美.25例横纹肌溶解症的临床特点分析[J].军医进修学院学报,2008,29(6):463-465.
[8]沈秀阳,景炳文,单红卫.5例非创伤性横纹肌溶解症的救治分析[J].中华急诊医学杂志,2012,21(12):1386-1388.
[9]陈旭峰,黄培培,康健,等.群发性横纹肌溶解症23例临床分析[J].中华急诊医学杂志,2010,19(10):1062-1065.
[10]李忠,孙家瑜,王忠,等.横纹肌溶解症的MRI诊断[J].临床放射学杂志,2009,28(10):1422-1424.
[11]贺发贵,李鑫宇,何志军,等.运动性横纹肌溶解致急性肾损伤22例病理特点与临床分析[J].中国中西医结合肾病杂志,2015,16(10):907-908.
[12]刘树坤,于晓华.运动性横纹肌溶解症流行病学特点[J].中国运动医学杂志,2011,30(8):764-767.
[13]唐吉刚,王树才,曹霞,等.劳力性热射病致横纹肌溶解症八例临床病理分析[J].中华神经科杂志,2013,46(7):454-457.
[14]许凡勇,夏进东,何瑶,等.皮肌炎并横纹肌溶解症CT及MRI表现一例[J].临床放射学杂志,2016,35(6):896-898.
[15]Mian AZ,Saito N,Sakai O.Rhabdomyolysis of the head and neck:computed tomography and magnetic resonance imaging findings[J].Dentomaxillofac Radiol,2011,40(6):390-392.