神经精神性狼疮MRI诊断

Assessment of magnetic resonance imaging on diagnosis of neuropsychiatric systemic lupus erythematosus

目的探讨神经精神性狼疮 (NPSLE)MRI表现特点和临床意义。方法 5 6例NPSLE病人在出现症状后 1d～ 2个月内进行头部MR检查。结果NPSLEMRI主要表现为皮层下斑点状和片状病变、脑梗死、出血、基底节区对称片状病变、桥脑中央髓鞘溶解症和脑萎缩。额、枕、顶叶和基底节区好发。片状的、边缘模糊的、T1WI等、略低信号 ,T2 WI高信号的病灶变化迅速。将MRI表现分为 4型 ,Ⅱ型仅表现为点状病灶的临床以头痛为主要表现 (39.89% ) ,Ⅲ型和Ⅳ型以癫痫为主要表现 (6 1.5 3% ,6 2 .5 0 % )。MRI发现片状病灶的病人较仅发现点状病灶者临床更易表现出定位体征 (P <0 .0 1)。结论NPSLE的MRI检查有助于明确脑病性质 ,更准确的评估病情和预后 ,从而指导治疗和评价疗效。

Objective To study the correlation of MRI special manifestations of neuropsychiatric SLE with clinical condition. Methods Fifty-six patients who fulfilled the diagnostic criteria of NPSLE were studied. MR imaging of the brain was performed within 1 day to 2 months after the onset of symptoms of encephalopathy, and the findings on imaging were analyzed combined with the clinical information. Results The MRI features of NPSLE including subcortical focal and diffuse lesions, infarcts, hemorrhage, symmertrical diffuse lesionsin in bilateral ganglions, central pontine myelinolysis and atrophy. The lesions are usually found in frontal, occopital,parietal lobe and ganglion. The iso- or hypo-intensity on T1WI, hyper-intensity on T2WI, blurry border and patch-like lesions might change quickly from day to day. All MRI manifestations were divided into 4 types. Type Ⅱusually have headache(39.89%) and those with seizure usually be found having diffused lesions.(typeⅢ 61.53%and typeⅣ62.50%). The increase of local physical symptoms was ascribed to the patches lesions (P<0.01). Conclusion Clinical applications of MR imaging in NPSLE can not only reveal the lesions character and help evaluate the state and prognosis of the illness, but also be of importance in guiding the therapy and in evaluating the response to treatment.