脑部炎性脱髓鞘假瘤MRI表现特点结合临床特征对临床的诊断价值

The Clinical Value of MRI Manifestations and Clinical Features of Inflammatory Demyelinating Pseudotumor of the Brain

目的 总结50例脑内炎性脱髓鞘假瘤影像特点及临床特征,以提高脑内脱髓鞘假瘤影像及临床诊断水平。方法 分析研究50例患者经过手术病理证实脑内炎性脱髓鞘假瘤19例,临床治疗证实炎性脱髓鞘假瘤31例。结果 采用采用GE Silent1.5T超导型MR扫描仪对50例患者行头颅检查获取影像图形,MRI检查50例患者共检出66个病灶均呈T1WI低信号、T_(2)WI高信号,T_(2)WI病灶中心呈极高信号影、边缘稍高信号影,DWI急性期、亚急性期病灶高信号影,随后信号逐渐减低,病灶ADC值降低。增强扫描60个病灶强化,6个病灶无强化,31个病灶不规则非闭合环状强化(半月征),开口朝向皮质或基底节区灰质,4个病灶环状强化、15个病灶垂直侧脑室火焰状强化并可见垂直于脑室的扩张静脉影,呈梳齿样结构(梳齿征),10个病灶不规则斑片状强化、6个病灶无强化。病灶形态主要为直径大于2cm类圆形,病灶也可以单发或者多发。临床表现也具有特征性;中青年多发,临床表现与脑内病灶数的多少没有直接关系,与病灶的位置密切相关,主要表现为头痛为首发、视力下降、认识功能下降、记忆力减退等特征,没有癫痫症状。结论 影像科诊断医生对脑内占位性病变有一定研究,对典型的影像特点掌握的比较好,很少结合临床特征去分析,存在一定的局限性,对于影像特点和临床特征对应关系把握不够,本文通过分析50例脑内炎性脱髓鞘假瘤患者影像特点结合临床特征,以提高脑内炎性脱髓鞘假瘤的诊断率。

Objective The imaging characteristics and clinical characteristics of 50 cases of encephalitis demyelinating Pseudotumor were summarized to improve the imaging and clinical diagnosis level of demyelinating Pseudotumor. Methods The analysis and study of 50 patients confirmed 19 cases of encephalitis-inflammatory demyelinoma after surgical pathology,and 31 cases of inflammatory demyelinoma confirmed by clinical treatment. Results Using GE Silent 1.5T superconducting MRscanner to obtain imaging graphics for 50 patients,MRI examination 30 patients detected a total of 66 lesions were T1WI low signal,T_(2)WI high signal,T_(2)WI lesion center is very high signal shadow,edge slightly higher signal shadow,DWI acute stage,subacute stage lesions high signal shadow,and then the signal gradually reduced,lesions AD. Enhanced scanning of 60 lesions fortification,6 lesions without reinforcement,31 lesions irregular non-closed ring reinforcement(half-moon signs),opening towards the cortical or substrate section gray mass,4 lesions ring strengthening,15 cases of lesions vertical lateral brain chamber flame-like reinforcement and can be seen perpendicular to the enlary vein shadow of the brain chamber,comb-like structure(comb signs),10 lesions irregular patch-like reinforcement,6 lesions without reinforcement. The form of lesions is mainly more than 2cm diameter round,lesions can also be single or multiple. Clinical manifestations are also characteristic;in middleaged and young people,clinical manifestations are not directly related to the number of lesions in the brain,and the location of lesions is closely related,mainly characterized by headache as the first,vision loss,decreased awareness function,memory loss and other characteristics,no epilepsy symptoms.Conclusion Imaging diagnostic doctors have some research on intra-brain occupied lesions,have a better grasp of typical imaging characteristics,rarely combine clinical characteristics to analyze,there are certain limitations,for imaging characteristics and clinical characteristics of the correspondence is not enough to grasp,This article analyzes the imaging characteristics of 50 patients with intracerebral inflammatory demyelinating pseudotumor combined with clinical features to improve the diagnosis rate of intracerebral inflammatory demyelinating pseudotumor.