桥脑梗死临床与磁共振成像类型特点(附77例分析)

Clinical Presentation and MRI Specificity of Acute Pontine Infarction,Analysis on 77-patient

目的:目前依靠临床表现确诊急性桥脑梗死难度较大。探讨磁共振成像检查尤其弥散加权成像(DWI-MRI)在早期诊断中的作用。方法:总结分析77例急性桥脑梗死临床与磁共振弥散加权成像(DWI-MRI),压水像(FLAIR-MRI),T1与T2加权成像及部分磁共振血管成像(MRA);电子计算机断层扫描(CT)等影像学特点的关系。结果:临床表现多种多样,以纯运动性卒中最多(35.1%);其它类型分占其余比例。首次诊断不准确率较高(36.4%)。在超急性期DWI-MRI即可明确显示桥脑梗死病灶区异常高信号;而Flair-MRI,T2、T1加权像异常改变小。急性期DWI-MRI明显高信号,T2和Flair-MRI开始出现稍高信号。根据影像学结果,桥脑梗死可分为①前中综合征、②前外侧综合症、③被盖综合症、④桥臂综合症、⑤双侧桥脑损害综合症、⑥单侧多发桥脑梗死或伴有小脑、枕叶、基底节或其他部位梗死等病损亚型,临床类型特点与发生机制不相同。结论:DWI-MRI对于临床表现不典型的桥脑梗死提供早期确诊与分型依据;其敏感性与特异性很高,具有不可替代作用。

Objective：Identification of acute pontine infarctiones as the cause of stroke appears quite uncertain based on clinical characteristics only.In this report,we briefly discuss the essential,technical aspects of MRI specificity among patients with pontine infarctiones. Methods：To analyse characteristics of 77-patient with acute pontine infarctiones and DWI-MRI,T1-weighted、T2-weighted、fluid-attenuated inverse recovery MRI and magnetic resonance angiography（MRA）、X-Ray Computed tomography（CT）with part cases. Results：Clinical presentation were usually varied.Pontine infarction with pure motor hemiparesis or hemiplegia is relatively greater part（35.1%）,the others displayed various clinical scenarios.Preliminary diagnosis were improper（36.4%）.In exceedingly acute phase,DWI-MRI with high intensity signals appeared,commonly called ＂positive＂ DWI-MRI of pontine infarctiones.At the same time,T1-weighted、T2-weighted MRI were not distinct.DWI-MRI could help precise pontine infarctiones subtyping.Based on the consequence of DWI-MRI,pontine infarctiones are classified into six types： ①anteromedial pontine syndrome,②anterolateral pontine syndrome,③tegmental pontine syndrome,④brachium pontis syndrome,⑤bilateral pontine syndrome and,⑥unilateral multiple ponting infarcts.MRI disclosed clinical presentation and pathogenesy of patients with acute pontine infarctiones. Conclusions：This study suggests that DWI-MRI help establish a diagnosis of acute pontine infarctiones even in cases where the clinical presentation is not typical for ischemic stroke.DWI-MRI is both sensitive and specific in the early detection of acute ischaemic brain lesions in the pons.