儿童高血压脑病的MRI表现

Brain MRI Findings of Hypertension Encephalopathy in Children

目的:探讨儿童高血压的脑部MRI表现。方法:搜集14例经临床确诊符合儿童高血压病的患者资料,治疗前后均行MRI检查,包括T1WI、T2WI、液体衰减反转恢复序列(FLAIR)和扩散加权成像(DWI),其中4例加行MRA,分析脑部累及的部位和信号变化特征,比较各序列在发现病灶、治疗随访和并发症监测中的作用。结果:双侧枕顶叶受累出现最早,皮层和皮层下白质同时受累,严重者可进一步累及双侧额叶和颞叶等部位。病变主要呈稍长T1、长T2信号,FLAIR序列显示病灶比T2WI敏感,其中1例不仅发现了T2WI阴性的病灶,而且MRI诊断早于临床诊断;4例治疗前MRA中,2例未见明显异常,2例表现为双侧大脑后动脉变细、走行僵直,边缘毛糙。血压降至正常后,临床症状改善早于影像学表现,FLAIR序列病灶消失晚于T2WI。结论:儿童高血压性脑病有一定特征,FLAIR序列是其重要的检查序列。

Objective：To study the MR findings of brain in hypertension children,and to improve the diagnosis level.Methods：Fourteen children with clinically proved hypertension were included.Conventional MRI and diffusion weighted imaging（DWI） were performed on all cases,and 4 cases received MRA additionally.The location and signal features were analyzed,and the values of each MR sequence in demonstrating lesion early,follow-up after treatment,and monitoring of severe complications were compared.Result：The cortical and subcortical white matters of bilateral occipital lobes both involved firstly,and some severe cases had bilateral frontal and temporal lobes involvement.Most of the lesions showed long T1 and long T2 signal,hyperintensity on FLAIR,and hypointensity on DWI.In one case,the lesions were detected only on FLAIR,and the clinical diagnosis was made after recognizing imaging findings that supported the diagnosis.In 2 of 4 cases,MRA showed no abnormal findings,and in the remaining 2 cases,posterior cerebral artery became thinner and stiff.After effective treatment,the clinical signs and symptoms were improved earlier than imaging findings.Hyperintensity of the lesion disappeared on FLAIR later than on T2WI.Conclusion：Cerebral changes in children with hypertensive encephalopathy have certain characteristic MRI features.FLAIR sequence plays a valuable role in the diagnosis of hypertensive encephalopathy in children.