狼疮脑病初次发病的MRI表现与诊断

The MRI Features in First Episode NPSLE

目的探讨狼疮脑病初次发病的MRI表现特点及其可能存在的病理机制。资料与方法回顾性分析15例经临床与实验室检查证实的活动性狼疮脑病患者初次发病的MRI资料,探讨MRI信号改变与病理机制的关系。结果 15例MRI均表现为较弥漫的异常信号,大脑半球、小脑、脑干及脊髓均可受累;病变主要位于皮髓质交界区,大多呈对称性分布。12例扩散加权成像(DWI)上呈高信号(其中3例部分病灶呈混杂信号),另3例病灶均呈高低混杂信号;15例液体衰减反转恢复序列(FLAIR)像上病变均为均匀高信号,境界清楚。增强扫描3例,1例有环形强化,2例无强化。14例治疗后复查MRI,11例病变明显好转,3例病变完全消失。结论病灶弥漫且大多对称的脑水肿样异常信号,DWI与FLAIR像上均出现高信号,可视为活动性狼疮脑病初次发病较具特征性的MRI表现,结合临床系统性红斑狼疮(SLE)病史与实验室检查不难做出诊断,积极治疗病变可以好转甚至完全消失。

Objective To evaluate the MRI features in first episode of active primary nervous system involvement in systemic lupus erythematosus [neuropsychiatric SLE（NPSLE）],and to interpret the findings in relation to possible underlying pathogenetic mechanisms.Materials and Methods The MRI findings of 15 patients with first episode NPSLE were analyzed retrospectively,and the correlation of imaging features with pathogenetic mechanisms were evaluated.Results（1）Diffuse abnormal MR intensity signals in brains were revealed in 15 cases.Cerebral hemispheres,cerebellum,brain stem and spinal cord were involved.Lesions mainly located in the junctional area of cortex and mudella,and were mostly symmetrical.（2）hyperintensity on DWI was detected in 14 cases,mixed intensity signals was detected in 3 cases.On T2-FLAIR,all the lesions were homogeneous hyperintense with clear edge.（3）After contrast injection in 3 cases,1 lesions showed rim enhancment,and another 2 lesions had no enhancement.（4）14 cases performed follow up MR examination after treatment.Lesions significantly improved in 11 cases and completely disappeared in 3 cases.Conclusion The MRI features in active first episode NPSLE were diffuse and symmetrical brain edema like signals（hyperintense on DWI and FLAIR）.It could be easier diagnosed by combining with medical history and laboratory examination.Lesions can be improved or even completely disappeared after proactive treatment.