系统性红斑狼疮性脑病的影像学表现及临床分析

Imaging and clinical manifestations of neuropsychopathy in systemic lupus erythematosus

目的探讨系统性红斑狼疮脑病(NPSLE)患者的CT、MRI表现及其与临床的关系。方法收集符合NPSLE诊断标准患者26例,对其临床表现、实验室检查及CT、MR影像学表现进行回顾性分析。结果临床表现:头痛、癫痫、脑血管意外、精神异常、颅内压增高等不同程度的神经精神症状。全部患者脑脊液检查存在异常。抗心脂抗体(ACL)阳性率为53.84%,抗核糖体蛋白(r-RNP)抗体阳性率为61.53%。影像表现:CT扫描阳性率为84.61%(22/26),MR扫描阳性率为92.30%(24/26)。CT主要表现为脑内灰白质弥漫性及局灶性低密度灶;MRI主要表现为大脑、小脑、脑干及深部白质的异常信号,T1WI呈低或等信号,T2WI呈高信号。脑萎缩12例,脑出血4例,基底节钙化7例。结论MR、CT的影像学表现可以对系统性红斑狼疮脑病的早期发现、鉴别诊断及疗效评价提供参考,但对系统性红斑狼疮脑病的诊断必须密切结合其他临床资料。

Objective To explore the CT and MR manifestations of neuropsychiatric systemic lupus erythematosus（NPSLE） in correlation with clinical condition.Methods Imaging findings,clinical data and laboratory examination of 26 NPSLE patients were analyzed retrospecticely.Results All patients experienced neuropsychic symptoms： headache,seizure,cerebrovascular accident,spirit abnormality,intracranial hypertension and meningitis.Laboratory examination of cerebrospinal fluid of 26 patients were abnormal.The positive rate of ACL were 53.84%,of antiribosomal P was 61.53%.The positive rate of CT finding was 84.61%（22/26）,of MRI was 92.30%（24/26）.CT showed diffuse and localized low density in the white and grey matter,while MRI presented iso-or low-signal on T1WI and high-signal on T2WI in cerebtum,cerebellum,deep white matter,basal ganglia and brain stem.Cerebral atrophy was detected in 12 cases,hemorrhage in 4,whereas basal ganglia calcification was found in 7 cases.Conclusion MRI and CT can provide valuable information for the early detection and differentiation of NPSLE,and for the evaluation of the treatment.For confirmation of the diagnosis,combination with the clinical data is necessary.