fMRI在中枢神经系统血管炎中的应用

Application of Functional Magnetic Resonance Imaging in Central Nervous System Vasculitis

目的分析中枢神经系统血管炎(CNSV)的MRI表现与特征,探讨f MRI对该病的诊断价值。方法对病理或临床证实的15例CNSV病例的MRI特点进行回顾性分析。结果随机分布多发病灶13例,幕上单发病灶2例。T1WI等或稍低信号13例,混杂信号2例;T2WI稍高或者高信号12例,混杂信号3例;全部病灶T2-FLAIR为高信号。DWI高信号病灶9例(6例夹杂点状低信号),等信号病灶3例,低信号灶3例。10例SWI扫描患者中均见渗出性微出血低信号,其中病灶侧静脉扩张6例,对侧静脉扩张1例。灌注成像8例,其中7例为略低灌注,1例灌注增高。增强扫描以斑片状、脑回样强化为主,2例T2WI高信号病灶未见强化,血管壁增厚伴明显强化9例,5例脑膜动脉强化,4例病灶周围软脑膜强化。11例TOF-MRA血管成像中,5例血管呈串珠样改变,1例大脑中动脉闭塞呈"Moya-Moya"病改变,5例血管未见异常。2例DSA均见血管呈串珠样改变,其中包含1例TOF-MRA阴性病例。CNSV确诊前MRI复查,7例出现新发病灶,6例原发病灶有进展,2例变化不大。13例CNSV经过激素冲击等对症治疗后复查MRI,11例原有病灶明显缩小或者吸收,1例见新发病灶,1例变化不明显。结论 CNSV具有特征性MRI表现,MRI检查有利于早期诊断及指导活检取材。

Objective To analyze the expression fractures of MRI and investigate the diagnostic value of functional magnetic resonance Imaging in central nervous system vasculitis（CNSV）. A4edlod8 MRI appearance of 15 cases of CNSV proved by pathology or clinical treatment were retrospectively reviewed, Results 13 multiple cases distributed randomly and 2 cases solitary supratentorial lesions were found. Equal or slight hypo- intensity in 13 cases and mixed intensity in 2 cases on T1WI. Slight hyper or hyper- intensity in 12 cases and mixed intensity in 3 cases on T2WI. Hyper-intensity in all cases on T2-flair. Hyper-intensity in 9 cases （6 cases with drop hypo-intensity）, equal intensity in 3 cases and hypo-intensity in 3 cases on DWI. Hypo-intensity of micro-bleeding in 10 cases on SWI, including phlebectasis of homolateral lesions in 6 cases and contralateral lesion in 1 case. Slight hypo-perfusion in 7 cases and slight hyper-perfusion in 1 case among 8 perfusion cases. Most of lesions demonstrated piebald or gyrus enhancement. 2 cases of hyper-intensity lesions on T2WI were not enhanced. Thickened and obviously enhanced vessel wall in 9 cases, enhanced meningeal artery in 5 cases and enhanced peripheral cerebral pia mater of lesions in 4 cases. Beading blood vessel in S cases, middle cerebral artery occlusion similar to Moya-Moya disease in 1 case and normal blood vessel in 5 cases anmng 11 TOF-MR.A cases. Beading blood vessel in 2 cases on 2 DSA cases, including l negative case on TOF-MRA. 7 cases of new lesions, 6 cases of advanced lesions and 2 cases of stable lesions were found before confirmed diagnosis of CNSV. 11 cases of obviously shrink or absorption lesions, 1 case of new lesion and 1 case of stable lesion were found with MR. after impulsion honnonotherapy. Conclusion Characteristic expression of CNSV on MR is benefit to early diagnosis of CNSV and to guiding biopsy.