常规MRI联合MR脑血管成像在围产期脑后部可逆性脑病综合征中的应用研究

Diagnosis of peripartum posterior reversible encephalopathy syndrome by routine MRI combined with MR cerebral angiography

目的:探讨常规磁共振成像(MRI)联合MR脑血管成像在围产期脑后部可逆性脑病综合征(PRES)诊断和鉴别诊断中的应用价值。方法:5例围产期PRES患者,平均年龄为26.5岁,且均于起病后2 d内行常规MRI和MR脑血管成像,MR脑血管成像包括MR脑动脉成像(MRA)和MR脑静脉成像(MRV)。结果:病变均累及双侧顶枕叶,另累及额叶2例,基底节区2例,桥脑1例,病变占位效应不明显。病变主要位于皮层下白质,其中1例累及皮质。病变T1WI呈低、等信号,T2WI及液体衰减反转恢复序列(FLAIR)呈高信号。3例磁共振扩散加权成像(DWI)呈等信号,表观扩散系数(ADC)图为高信号,另2例部分病变DWI为高或稍高信号。增强扫描以上病变未见明确强化,MRA、MRV未见明确异常。结论:围产期RPES的MRI表现较具特征性,常规MRI联合MR脑血管成像有助于本病的早期诊断和鉴别诊断。

Objective：To investigate the application of MRI combined with MR cerebral angiography in the diagnosis and differentiation of peripartum posterior reversible encepttalopathy syndrome （PRES）. Methods： The present study included five peripartum patients who were diagnosed as PRES with mean age of 26.5 years. MR1 was performed 2 days after onset. Besides routine MRI,MR cerebral angiography was also performed which included magntic resonance arteriography （MRA） and magnetic resonance venography（MRV）. Results： MRI showed bilateral parietal- occipital lobe was involved in all cases, frontallobe in 2 cases, basal nucleus in 2 cases, and pons in one case. There was no obvious space-- occupying effect in all lesions. The lesions in the occipital, parietallobe and frontallobe were situated in subcortical white matter, and the cortex was also involved in one patient. The lesions were hypoisointense on T1 weighted images, and hyperintense on T2 weighted and fluid- attenuated inversion recovery （FLAIR） images,respectively. On diffusion weighted imaging （DWI）, the lesions appeared as isointense, and on apparent diffusion coefficient （ADC） map,the lesions were hyperintense in 3 cases. Some of the lesions in other two cases were hyperintense or slight hyperintense on DWI. The enhanced MRI, MRA,and MRV were normal. Conclusion：The MR findings of peripartum PRES are quite characteristic. Routine MRI combined with MR cerebral angiography are helpful for the further diagnosis and differentiation diagnosis.