继发于脑干病变的肥大性下橄榄核变性的磁共振成像特点

MRI features of hypertrophic olivary degeneration secondary to brainstem lesions

目的分析继发于脑干病变的肥大性下橄榄核变性(HOD)的磁共振成像(MRI)表现,探讨MRI对肥大性下橄榄核变性的诊断价值。方法回顾性分析18例脑干病变继发肥大性下橄榄核变性(HOD)的磁共振表现与动态变化。18例均采用Siemens 3.0T MRI检查,行T1WI、T2WI、T2水抑制序列、磁共振弥散加权成像(DWI)序列扫描;其中5例行磁共振扩散张量成像(DTI)扫描。结果18例HOD中10例为单侧,8例为双侧。18例中13例MRI表现为一侧或者双侧下橄榄核体积增大。信号变化为:下橄榄核T1WI呈等或稍低信号,T2WI及T2水抑制序列呈高或稍高信号,DWI呈等或稍高信号,表观扩散系数(ADC)图呈等信号。DTI显示原发病及下橄榄核病变区神经纤维束相对正常侧减少并部分呈现中断现象。结论HOD多继发于齿状核-红核-下橄榄核环路病变,有特定的发病部位和较为特征性的MRI表现,高场MRI特别是结合DTI序列可对HOD的诊断提供可靠依据,对定性诊断及鉴别诊断具有重要的临床价值。

Objective To analysis the secondary to the brainstem lesions of hypertrophic olive MRI manifestation of Wilson(HOD).To explore the MRI in the diagnosis of hypertrophic next olives nucleus degeneration value.Methods Magnetic resonance manifestations and dynamic changes of HOD with secondary hypertrophy in 18 cases with brainstem lesions were retrospectively analyzed.All the 18 patients underwent Siemens 3.0T MRI,and were scanned with T1WI,T2WI,T2 water inhibition sequence and DWI sequence.Five of them underwent DTI scanning.Results In 18 HOD cases,10 cases were unilateral and 8 cases were bilateral.MRI of 13 of the 18 patients showed unilateral or bilateral enlargement of the inferior olive nucleus.Signal changes were as follows:lower olive core T1WI showed equal or slightly lower signal,T2WI and T2 showed high or slightly higher signal,DWI showed equal or slightly higher signal,and ADC map showed equal signal.DTI showed that the neural fiber bundles in the primary and lower olivine nucleus lesions were reduced and partially interrupted.Conclusion HOD mostly secondary to dentate nucleus-red nucleus-inferior olive nucleus loop lesions,with specific sites and more characteristic MRI findings.High field MRI,especially in combination with DTI sequence,can provide reliable basis for HOD diagnosis and has important clinical value for qualitative diagnosis and differential diagnosis.