一氧化碳中毒性脑病的MRI弥散加权成像表现与预后的关系

Correlation between Diffusion Weighted MRI Manifestations and Prognosis in Carbon Monoxide Poisoning Encephalopathy

目的：探讨一氧化碳中毒（COP）性脑病的磁共振弥扩散加权成像（MQ-DWI）表现与预后的关系。方法对34例COP 性脑病患者的磁共振影像学、临床表现及预后进行回顾性分析。结果所有患者均及时给于高压氧和药物对症治疗。13例轻度中毒者经临床治疗后均痊愈，随访1～2个月无异常；5例中度中毒者随访3～6个月，其中1例出现迟发性脑病，4例痊愈；16例重度中毒者随访3～6个月，13例出现 COP 迟发性脑病（4例死亡），3例痊愈。影像学表现：单纯基底节区受累（10例）及单纯脑皮层受累（2例）患者，MR 表现均表现为对称性稍长 T1稍长 T2信号，均痊愈；单纯脑白质受累（3例），MR 表现为双侧大脑白质内对称性稍长 T1稍长 T2信号，DWI 为稍高信号，2例痊愈，1例出现迟发性脑病；双侧基底节区及脑白质或双侧基底节区及脑皮层同时受累（16例），MR 表现为受累区域对称性稍长 T1稍长 T2信号，FLAIR 序列及 DWI 均为高信号，3例痊愈，13例出现 COP 迟发性脑病（4例死亡）；MR 表现为正常3例，FLAIR 序列及 DWI 未见明显高信号，均痊愈。结论MR-DWI 对 COP 性脑病患者的预后判断有重要的临床价值，DWI 信号越高，预示着脑白质脱髓鞘改变越严重、发生迟发性脑病的概率越大、临床预后也越差。

Objective To investigate the correlation between diffusion weighted magnetic reso-nance imaging（MRI）manifestations and prognosis in carbon monoxide poisoning（COP）encepha-lopathy.Methods MRI manifestations,clinical features and prognosis of 34 patients with COP encephalopathy were analyzed retrospectively.Results All patients were timely given hyperbaric oxygen and symptomatic drug treatment.Among the 34 patients,13 patients with mild poisoning were cured and showed no abnormalities after 1-2 months of follow-up.Among the 5 patients with moderate poisoning who were followed up for 3-6 months,1 had delayed encephalopathy and 4 were cured.Among the 16 patients with severe poisoning who were followed up for 3-6 months, 13 had delayed encephalopathy（4 died）and 3 were cured.MRI showed symmetrically slightly long T1 and T2 signals in 10 patients with basal ganglia involvement and 2 patients with cerebral corti-cal involvement （all of them were cured）,symmetrically slightly long T1 and T2 signals and slightly high DWI signal in bilateral white matter in 3 patients with white matter involvement（2 were cured and 1 had delayed encephalopathy）,symmetrically slightly long T1 and T2 signals and＆amp;nbsp;high FLAIR and DWI signals in the involved area in 16 patients with simultaneous involvement of bilateral basal ganglia and cerebral white matte or bilateral basal ganglia and cerebral cortex（3 were cured and 13 had delayed encephalopathy）,and normal without high FLAIR and DWI sig-nals in 3 patients（all of them were cured）.Conclusion Diffusion weighted MRI is of great clinical value in determining the prognosis of patients with COP encephalopathy.The DWI signal is posi-tively correlated with cerebral white matter demyelination and delayed encephalopathy,but nega-tively correlated with clinical prognosis in patients with COP encephalopathy.