脑后部可逆性脑病综合症:MRI诊断及对预后的判断

Diagnostic and prognostic value of MR in posterior reversible encephalopathy syndrome

目的探讨脑后部可逆性脑病综合症的MRI诊断及其对预后的判断价值。方法回顾性分析7例PRES患者的MRI资料并进行追踪随访。7例患者均行T1WI、T2WI、水抑制序列(FLAIR)成像及扩散加权成像(DWI)。结果MRI显示PRES以顶枕叶白质为主的片状对称性长T1长T2信号、FLAIR高信号病变,部分累及皮层,颞叶后部、额叶或小脑也可有相同性质的小片状病灶受累。病灶DWI图呈等信号3例,略高信号2例,高信号1例,病灶DWI及ADC图呈混杂小片状低信号1例。经积极治疗随访发现,DWI呈等信号或略高信号者预后较好,DWI呈高信号及DWI和ADC图均显示低信号者预后较差。结论PRES的MRI表现具有鲜明的特征性,扩散加权成像对预后判断具有重要的临床价值。

Objective To investigate the diagnostic and prognostic value of MRI in posterior reversible encephalopathy syndrome. Methods 7 cases of posterior reversible encephalopathy syndrome with MRI data were retrospective analyzed and they were followed up. All of them had underwent MR imaging（T1WI, T2WI,FLAIR,DWI）. Resuits MRI revealed symmetrical multiple patchylike lesions presented hypointense on T1WI, hyperintense on Z2WI, and located predominantly in the occipital lobe, some of them involved gray matter. They could provide useful imformation in the bilateral tem- poral lobes, frontal lobe and cerebellum. The lesions demonstrated mild high signal in 2 case, high signal in l case, and no signal changes in 3 case on DWI, low signal in 1 case on DWI and ADC. After aggressive treatment and followed-up, it showed that patients who had mild high signal or slightly higher signal on DWI had better prognosis, and who had high signal on DWI or low signal on both DWI and ADC had poor prognosis. Conclusion MRI manifestations of PRES have distinctive characteristic, Diffusion-weighted imaging for judging the prognosis has important clinical value.