脑梗死后继发中脑黑质变性的MRI诊断

MRI diagnosis of secondary degeneration of the mesencephalic substantia nigra after cerebral infarction

目的:分析脑梗死后继发中脑黑质变性的MRI影像学表现,以提高对其MRI征象的认识。方法:对2015年1月至2017年12月19例经临床证实的脑梗后继发中脑黑质变性患者的临床和影像学资料进行回顾性分析。结果:19例患者中,心源性脑梗死13例(68.42%),动脉粥样硬化性脑梗死5例(26.32%),病因不明性脑梗死1例(5.26%)。血管闭塞/狭窄及脑梗死部位:颈内动脉5例(26.32%),大脑中动脉M1段13例(68.42%),大脑中动脉M2段1例(5.26%);纹状体梗死3例(15.79%),纹状体和皮层梗死16例(84.21%)。发病后MRI检出时间为4～28 d,平均(13.11±5.96) d;与正常脑白质相比,中脑黑质变性在DWI、FLAIR及T2WI上的主要表现是边界欠清的高信号影。结论:MRI可对脑梗死后继发黑质变性作出明确诊断。

Objective:To analyze MRI appearances of secondary degeneration of the mesencephalic substantia nigra after cerebral infarction in order to improve the recognition of MRI signs of the disease.Methods:The clinical data and MRI findings of 19 patients with secondary degeneration of the mesencephalic substantia nigra after cerebral infarction from January 2015 to December 2017 were analyzed.Results:Among these patients,13 were cardiogenic cerebral infarction(68.42%),5 were atheromatous cerebral infarction(26.32%),1 was etiology unknown cerebral infarction(5.26%).The location of occluded/stenosis vessel and cerebral infarction:5(26.32%)were internal carotid artery occluded/stenosis,13(68.42%)were middle cerebral artery M 1,1(5.26%)was M 2 occluded/stenosis,3(15.79%)were striatal cerebral infarctions and 16 patients(84.21%)were striatal and cortical cerebral infarctions.Check out time of MRI was 4-28 days and mean time was(13.11±5.96)days after the onset of the disease.Compared with normal white matter,substantia nigra degeneration showed hyperintense signal with unclear boundary on diffusion-weighted imaging and fluid-attenuated inversion recovery and T 2 WI MRI.Conclusion:MRI can make a definitive diagnosis of secondary degeneration of the mesencephalic substantia nigra after cerebral infarction.