产褥期神经系统疾病的临床及MRI表现对照研究

CLINICAL AND MRI COMPARATIVE STUDY OF NERVOUS SYSTEM DISEASE IN PUERPERIUM

目的分析并对比产褥期脑后部可逆性脑病综合征、静脉窦栓塞、脑梗塞、脑炎的临床及MRI影像学表现,探讨MRI特定序列在产妇神经系统疾病的鉴别诊断、治疗和预后评估中的价值。方法回顾性分析35例产褥期神经系统疾病患者的临床及MRI资料。35例患者均行MRI检查,检查序列包括:T1WI、T2WI、FLAIR/T2WI、DWI、ADC值的测定及MRV。比较不同疾病的临床表现,并分析其颅内病灶的信号特征,评价MRI不同序列在鉴别诊断及治疗评估中的作用。结果 PRES颅内病灶具有多发性、对称性,多示为T1WI低信号、T2WI高信号、DWI高信号、ADC值减低;CVST颅内病灶与其引流的静脉窦血栓形成部位相一致,多示为T1WI低信号、T2WI高信号,合并出血时夹杂点片样T1WI高信号,DWI低信号、ADC值增高;脑梗塞颅内病灶与相应动脉分布区相一致,多示为T1WI低信号、T2WI高信号、DWI低信号、ADC值增高;脑炎颅内病灶具有多发性,多示为T1WI低信号、T2WI高信号、DWI低信号、ADC值增高。结论产后脑后部可逆性脑病综合征、脑梗塞、脑炎、静脉窦栓塞临床及影像学表现各有相似及不同之处,MRI是首选影像诊断手段,FLAIR/T2WI序列可以提高病变的检出率,MRV、DWI及ADC值的测定对正确诊断和预后有重要价值。

Objective： To analyze and contrast the clinical and imaging findings and explore the value of specific sequences of magnetic resonance imaging （MRI） in the diagnosis and cure of parturient with posterior reversible encephalopathy syndrome （PRES）, cerebral venous-sinus thrombosis （CVST）, cerebral infarction （CI） and encephalitis. Methods： The clinical and MRI imaging data of 35 patients with central nervous system disease were retrospectively studied. All of the patients received MRI examination with the sequences of TIWI, T2WI, FLAIR/T2WI, DWI, ADC and MRV. The clinical features and the characteristic signals of cerebral lesions were analyzed and compared, and the values of MRI different sequences in the diagnosis and treatment were evaluated. Results： The encephalic niduses of PRES were multifocal, symmetry, and showed low TIWI signal, high T2WI and DWI signal, and lowing ADC map. The position of encephalic niduses of CVST was in agreement with its drainaged venous sinus thrombosis with low TIWI and high T2WI signal, andthey may be mingled with high T1WI and low DWI signal, increasing ADC map, if they were of bleeding. The position of encephalic niduses of CI was found in agreement with the corresponding artery distribution area with low T1WI and DWI signal, high T2WI signal and ADC map. The encephalic niduses of encephalitis were multifocal and showed low T1WI and DWI signal, high T2WI signal and increasing ADC map. Conclusions： There are similarity and difference in the clinical and imaging findings ofPRES, CVST, CI and encephalitis. MRI is the first choice of the diagnosis, FLAIR/T2WI could increase the detection rates of the lesion, MRV, DWI, ADC examination are important in the correct diagnosis and prognosis.