超声造影在运动性横纹肌溶解综合征中的应用

Application of contrast-enhanced ultrasound in motor rhabdomyolysis syndrome

目的探讨超声造影在运动诱发的横纹肌溶解综合征(exertional rhabdomyolysis,ERM)中的诊断应用及特征性表现。方法选取解放军总医院第一医学中心2019年8月收治的3例ERM患者,采集其临床资料,包括病史、血清肌酶、肌电图、股骨肌磁共振成像(MRI)以及发病后1周内股骨肌超声造影动态图像等,并对其进行分析和总结。结果3例患者均为运动后出现肌肉酸痛、尿色深,血清肌酶升高均超过5倍正常值,明确诊断为ERM。患者骨骼肌MRI呈等或稍长T1、去脂长T2液体衰减反转恢复序列、高弥散加权成像信号。1例股骨肌MRI显示长收肌、半腱肌病变,其余2例显示股四头肌病变,3例MRI分级均为1级。病变骨骼肌普通超声均可见回声增强。超声造影呈动态强化过程,病损肌肉中心区首先出现强化,逐渐外周出现强化,呈同心圆强化过程。运动诱发的骨骼肌病损动态超声造影有特征性改变,中心区强化早且明显,呈不均一性强化特点,中心区病变更明显。结论ERM病变骨骼肌动态超声造影检查有其特征性的改变。病损中心区强化出现早且明显,周围出现晚且强化弱,呈“水波纹”同心圆强化特点,这种强化特点提示ERM骨骼肌不均一受损,中心区更明显。

Objective To explore the diagnostic application and characteristics of contrast-enhanced ultrasound in exertional rhabdomyolysis(ERM).Methods Three cases of ERM patients admitted to Department of Neurology,the First Medical Center of Chinese People′s Liberation Army General Hospital in August 2019 were selected and clinical data of the patients were collected including medical history,serum muscle enzyme,electromyography,magnetic resonance imaging(MRI)and dynamic contrast-enhanced ultrasound of the thigh muscles within one week after onset.Results All three patients had muscle soreness and dark urine after exercise and their serum muscle enzyme level exceeded five times of normal value which could be definitely diagnosed as ERM.Skeletal muscle MRI showed equal or slightly longer T1,longer fat-suppressed T2 weighted fluid attenuated inversion recovery images,and high diffusion weighted imaging signal.In this group,one case of femur muscle MRI showed adductor longus and semitendinosus myopathy,other two cases showed quadriceps.All cases′MRI score was grade one.Echogenic enhancement can be seen in normal ultrasound of diseased skeletal muscle.Contrast-enhanced ultrasound showed a dynamic strengthening process in which the central area was firstly strengthened,then strengthened in peripheral area.Dynamic contrast-enhanced ultrasound showed characteristic changes in ERM with early and obvious enhancement in the central area and uneven enhancement in the central area.Conclusions Dynamic contrast-enhanced ultrasonography of ERM lesions has its characteristic changes.The enhancement of the central area of the lesion appeared early and obvious while the surrounding area appeared late and weak,showing the characteristic of"water ripple"concentric circle reinforcement.This enhancement characteristic suggested that ERM skeletal muscle was unevenly damaged and the central area was more obvious.