探讨急性一氧化碳中毒及迟发性脑病的MRI诊断价值

Investigation on diagnostic value of MRI for acute carbon monoxide poisoning and delayed encephalopathy

目的探讨急性一氧化碳中毒(ACOP)及迟发性脑病(DEACMP)磁共振成像(MRI)的临床特点。方法 27例ACOP并DEACMP患者均在最初和"假愈期"进行MRI扫描并记录评价扫描结果。结果 27例患者中,首次MRI扫描3例无明显异常信号;24例显示双侧苍白球T1WI低、T2WI高信号、FLAIR及DWI呈高信号,两侧对称,其中2例合并双侧放射冠区、半卵圆中心脑白质T1WI稍低、T2WI稍高信号,FLAIR及DWI呈稍高信号。"假愈期"后MRI复查,DEACMP以双侧侧脑室周围、放射冠区、半卵圆中心脑白质改变显著,27例均显示双侧侧脑室周围、双侧放射冠区、半卵圆中心弥漫性T1低、T2高信号、FLAIR及DWI高信号;19例合并内囊、外囊T1低、T2高信号及FLAIR、DWI高信号;11例合并双侧苍白球软化、坏死,呈T1低T2高信号、FLAIR及DWI呈内部低边缘高信号;7例合并双侧尾状核对称性T1高、T2稍高信号、FLAIR及DWI呈稍高信号;2例合并双侧大脑脚、丘脑T1高、T2稍高信号、FLAIR及DWI呈稍高信号;1例合并双侧前联合、海马T1高、T2稍高信号、FLAIR及DWI呈稍高信号。结论 MRI用于诊断ACOP并DEACMP具有重要意义,是最佳影像学检查方法。

Objective To discuss the clinical features of magnetic resonance imaging （MRI） of acute carbon monoxide poisoning （ACOP） and delayed encephalopathy after acute carbon monoxide poisoning （DEACMP）. Methods A total of 27 patients with ACOP and DEACMP underwent MRI scans at the beginning and during the ＂false recovery period＂ and recorded the results of the evaluation scan. Results Of the 27 cases, 3 cases showed no obvious abnormal signal in the first MRI scan, 24 cases showed T1WI low and T2WI high signal in bilateral globus pallidus, high signal in FLAIR and DWI, bilateral symmetry, including 2 cases with T1WI low and high signal of bilateral radiography canopy, semi-oval central white matter and high FLAIR and DWI signal. After the ＂false recovery period＂, MRI reexamination showed that DEACMP with significant changes in bilateral lateral ventricle, radiological crown area, and semi-oval central white matter, and 27 cases showed diffuse T1 low, T2 high signal, FLAIR and DWI high signal in bilateral lateral ventricle, radiological crown areal and semi-oval central white matter. 19 cases had combined internal capsule, external capsule T1 low, T2 high signal, FLAIR and DWI high signal. 11 cases with bilateral globus pallidus softening and necrosis, showed T1 low T2 high signal, internal low-edge high signal in FLAIR and DWI. 7 cases with bilateral caudate nuclear symmetry T1 high and, T2 slightly high signal, and slightly high signal in FLAIR and DWI. 2 cases with bilateral brains, T1 high, slightly high T2 signal in thalamus, and slightly high FLAIR and DWI signals. 1 case with bilateral anterior joint, high T1 and slightly high T2 signal in hippocampus, and slightly high signal in FLAIR and DWI. Conclusion MRI is of great significance in the diagnosis of ACOP and DEACMP, and is the best imaging examination method.