CT和MRI对桥脑中央髓鞘溶解症的诊断价值

Value of CT and MRI for diagnosing Central Pontine Myelinolysis

目的:探讨桥脑中央髓鞘溶解症(CPM)的CT、MRI表现,以提高诊断水平,并评估其在CPM诊断及随访中的价值。方法:回顾性分析8例经我院临床确诊的CPM的临床和影像学资料,总结其影像学特征。结果:4例患者行CT检查,其中阳性2例,阴性2例,阳性病例中桥脑、双侧大脑脚及右侧小脑多发斑片状低密度灶1例,桥脑低密度灶1例;8例患者行MRI检查均有阳性表现,其中桥脑中央病灶8例,对称性分布,边缘清晰,呈圆形、卵圆形或蝶翼状,4例伴桥脑外病变,包括小脑半球、大脑脚、丘脑、基底节及放射冠等区域,病灶在T1WI序列均呈等、低信号,T2WI及T2FLAIR序列呈高信号,DWI序列呈明显高信号,灶周无水肿,增强扫描未见强化。结论:MRI对该病的诊断价值明显优于CT,T2FLAIR及DWI序列对CPM病灶显示敏感,对其诊断、指导临床治疗及评估预后具有较大价值。

Objective： To analyze the CT and MRI features of central pontine myelinolysis（CPM） to improve diagnostic level and determine the value of CT and MRI in the diagnosis and follow-up of CPM. Methods： Retrospectively analyzed the clinical and imaging features of 8 patients with confirmed CPM and summarized the imaging features. Results： 4 patients underwent CT examination, 2 patients＇ CT scan testing revealed abnormal results：the low density lesions were found at pontine, bilateral cerebral peduncle and right cerebellum in one patient,the other one showed low density lesions at pontine. The remaining 2 patients had normal CT scan results. 8 patients underwent MRI scan has a positive findings which revealed pontine lesions in all cases. It showed symmetrical distribution, clear edge, round, oval or butterfly. 4 of which accompanied extrapontine lesions include hemisphaerium cerebelli, caudex cerebri,thalami,basal ganglia and radiate infarction.The lesions showed iso/hypointensity in T1 WI, hyperintensity in T2 WI, T2 FLAIR,markedly hyperintensity in DWI sequence, with no edema around the lesion and no enhancement. Conclusion： The diagnostic value of MRI in the diagnosis of CPM was significantly better than CT, especially in T2 FLAIR and DWI sequence. It has great value in diagnosis early,guideline of clinical therapy and estimation prognosis diagnosis.