神经梅毒的MRI表现(2例报告并文献复习)

MR presentations of neurosyphilis: report of two cases and review of literature

目的:探讨神经梅毒的MRI表现。方法:1例血清和脑脊液密螺旋体抗体检测阳性,经青霉素治疗后临床症状消退。另1例血清密螺旋体抗体阳性手术后病理证实为脊髓梅毒树胶样肿。2例均行MRI检查。结果:1例脑实质性梅毒表现为右侧颞叶内侧T1WI呈略低信号,T2WI呈均匀高信号,DWI及FLAIR呈高信号。1例脊髓树胶样肿表现为T1WI为低信号或等、低混杂信号灶,呈类圆形,T2WI为等高混杂信号灶;钆喷替酸葡甲胺(Gd-DTPA)增强T1WI示病灶呈不规则环形强化,并与背侧脊膜以钝角相交。结论:神经梅毒的MRI表现多种多样,对其的认识很重要以达到早期诊断和治疗的目的。

Objective：To investigate the MR presentations in neurosyphilis.Methods：One case of paren-chymatous neurosyphilis with positive treponemal antibody in the serum and cerebrospinal fluid was cured by penicilin therapy,and the other case of syphilitic gumma in the spinal marrow with positive treponemal antibody test in the serum was confimed pathologically after operation.Both patients were examined by MRI.Results：The MR presentations of paren-chymatous neurosyphilis were that the right mesial temporal region was shown as low or mixed low and isosignal intensity on T1WI.The lesion showed evenly hyperintensity on T2WI,as well as on the DWI and FLAIR.The MR presentations of syphilitic gumma in the spinal marrow were that the roundish areas of low signal or mixed low and iso-signal intensity were shown on T1WI,the lesions showed high signal or mixed high and iso-signal intensity on T2WI.Gd-DTPA enhanced T1WI demonstrated irregular circular enhancement,and the border of the lesions was angulated with neighboring dorsal meninges by obtuse angle.Conclusion：Neurosyphilis has a wide variety of MR manifesitons and identification of the more common MR appearances of neurosyphilis is important to initiate early diagnosis and treatment.