可逆性后部白质脑病综合征的CT及磁共振成像表现

CT and MRI manifestations of posterior neversible encephalopathy syndnome

目的探讨可逆性后部白质脑病综合征(PRES)的CT及磁共振成像(MRI)表现。方法回顾性分析8例可逆性后部白质脑病综合征患者的影像学特征,其中女性7例,男性1例。8例患者行MRI扫描,包括T_1WI、T_2WI、液体衰减反转恢复序列(FLAIR)成像及扩散加权成像(DWI),其中2例同时行增强MRI及MRI血管成像(动脉及静脉成像);其中4例行CT平扫。结果病灶累及双侧顶枕叶白质区4例,额颞叶白质区3例,其中累及灰质者5例,基底节区、脑干、小脑受累1例。病变CT表现为白质区多发斑片状低密度,MRI呈对称性T_1低T_2高信号,FLAIR呈高信号,DWI等低信号,表观扩散系数(ADC)图呈高信号6例,ADC图等信号2例,颅内动脉纤细2例,MRI增强显示病灶部位脑膜线样强化1例。结论 PRES的典型影像学征象是双侧顶枕叶白质区多发对称性血管源性水肿,灰质也可受累,FLAIR是显示病灶的最佳序列。

Objective To study the MRI and CT features of posterior reversible encephalopathy syndrome （PRES）, Methods Imaging data of 8 patients（seven is famale,one is male ） with PRES were analyzed retrospectively. MR examination was performed on all the patients including T2W, T1W, FLAIR sequence and DW images. Two patients received contrast enhanced MR scan and MR angiography and venography, four patients underwent CT scan. Results The lesions located in the white matter of bilateral parietal occipital lobes（4 patients）, frontotemporal lobes （3 patients）, gray matter involvement 5 patients. Basal ganglia, brainstem, and cerebellum were involved（1 patient）. The lesions in white matter showed multiple patchy hypodensity on CT images, and appeared as symmetrical long T1 and long T2 signal on MRI,hyperintense signal on FLAIR,iso intense signal on DWI and hyper or iso intensity on apparent diffusion coefficient （ADC） maps. Thin intracranial artery（2 patients）, dural enhancement of the lesion site with MR enhancement （1 patient）. Conclusion The typical imaging features of bilateral occipital lobe white matter area are multiple symmetrical vascular edema, and gray matter can also be affected. FLAIR is the best sequence of the lesions.