神经白塞病的影像学特点和动态变化

Imaging characteristics and dynamic changes of Neuro-Behcét's disease

目的总结神经白塞病在不同序列MRI检查上病灶的好发部位和特点。方法回顾性分析7例神经白塞病患者的MRI检查资料。MRI检查序列包括:T1WI、T2WI、核磁共振弥散加权成像、表观弥散系数和核磁共振波谱。结果 7例神经白塞病患者均表现为脑实质损害。最常见的神经系统症状包括癫痫发作、头痛、躯体感觉和运动障碍、延髓麻痹、精神障碍、认知障碍和锥体束征。MRI检查常见受累部位包括脑干、内囊、皮质下白质和基底节。病灶在MRI上表现为T1WI为等信号或低信号,T2WI为高信号,其中3例可见异常强化。2例神经白塞病患者表现为核磁共振弥散加权成像稍高信号,表观弥散系数信号轻度升高,核磁共振波谱未见明显异常代谢区。3例患者在首次MRI检查后15d～5个月进行随访发现原发病灶均减少或消失,但可出现新发病灶。结论神经白塞病是白塞病最严重的并发症之一,MRI检查是诊断神经白塞病非常敏感的方法,神经白塞病以脑实质损害为主,不同序列的MRI检查具有特征性改变。

Objective To summarize the locations and patterns of neuro-Behcét＇s disease（NBD） in brain by MR imaging.Methods Seven patients with NBD examinated by MRI were reviewed.MRI examinations included the following sequences： T1WI,T2WI,diffusion weighted imaging,apparent diffusion coefficient and magnetic resonance spectroscopy.Results Parenchymal lesions were identified in all 7 patients.Most common neurologic symptoms included epilepsy,headache,somatic sensorial and autonomic disorders,bulbar palsy,emotional disturbance,cognitive disorder and pyramidal signs.Brainstem,internal capsule,cerebral white matter and basal ganglia were frequently involved.The lesions were of iso or low signal intensity on T1WI and high signal intensity on T2WI,contrast-enhancement was observed in 3 patients.In 2 cases there was slightly hyperintense on diffusion weighted imaging,and the apparent diffusion coefficient was slightly increased.Magnetic resonance spectroscopy was normal.Follow-up MRI was obtained from 15 days to 5 months after the initial MRI in 3 cases,all primary lesions decreased or disappeared,but new lesions might appear.Conclusions NBD is one of the most serious complications of Behcét＇s disease.MRI is a very sensitive diagnostic method for NBD.It is confirmed that brain parenchyma injury is the main characteristic of NBD and different sequences of MRI examination has a characteristic change.