扩散加权成像诊断散发性Creutzfeldt-Jakob病价值

Diagnostic value of diffusion-weighted imaging on sporadic Creutzfeldt-Jakob disease

目的评价扩散加权成像(DWI)对散发性Creutzfeldt-Jakob病的临床诊断价值。方法回顾性分析21例临床诊断为很可能Creutzfeldt-Jakob病患者临床和MRI资料,总结其DWI特征。结果21例散发性Creutzfeldt-Jakob病患者DWI表现为大脑皮质"飘带"样高信号、尾状核和(或)豆状核高信号。异常信号发生部位以大脑皮质合并基底节区最常见(16例,76.19%),单纯皮质受累3例(14.29%)、单纯基底节区受累2例(9.52%);大脑皮质病灶中以额叶受累最常见(15例,78.95%),其次依次为顶叶(13例,68.42%)、颞叶(12例,63.16%)和枕叶(9例,47.37%)。与常规MRI相比,DWI显示病灶更清晰,病灶部位表观扩散系数值下降。21例中5例随访时,DWI高信号强度和范围有所变化,仅1例异常信号范围缩小。结论散发性Creutzfeldt-Jakob病的DWI表现具有一定特异性,推荐作为拟诊散发性Creutzfeldt-Jakob病的检查方法。

Objective To explore the diagnostic value of diffusion-weighted imaging （DWI） on sporadic Creutzfeldt-Jakob disease （sCJD）. Methods The MRI findings of 21 patients with clinically proved probable sCJD were analyzed retrospectively and the characteristics were summarized especially in DWI. Results 1） All 21 cases of sCJD were shown abnormal in DWI, which appeared as linear hyperintensity signals in cerebral cortex and patchy hyperintensity in eaudate nucleus and （or） lenticular nucleus. 2） The abnormal signals were most commonly seen in cerebral cortex accompanied with the basal ganglia （16 cases, 76.19%）. Besides, there were 3 cases of cortex involvement （14.29%） and 2 cases of basal ganglia involvement （9.52%）. Among the lesions in cerebral cortex, the frontal and parietal lobes were affected more commonly （15 cases, 78.95%; 13 cases, 68.42%） than the temporal and occipital lobes （12 cases, 63.16%; 9 cases, 47.37%）. 3） DWI was superior to T1WI, T2WI and FLAIR imaging sequences. The abnormal signals in DWI were accompanied by decreased apparent diffusion coefficient （ADC） values. 4） During the follow-up in 5 patients, the range and intensity of high signal changed in DWI, and only one case presented reduced range of abnormal signal. Conclusions sCJD manifests characteristic changes on DWI, which should be suggested as an essential tool for diagnosing sCJD.