探讨多模态MRI检查对成人MELAS型线粒体脑肌病的诊断价值

To Investigate the Diagnostic Value of Mu ltimodal MRI in Adult MELAS Mitochondrial Encephalomyopathy

目的探讨多种功能磁共振成像的联合应用在成人线粒体脑肌病伴乳酸血症和卒中样发作(mitochondrial encephalomyopathy,lactate acidosis and stroke-like episodes,MELAS)中的诊断价值。方法1例MELAS患者,除了CT平扫、常规MRI检查序列,补充了病人MR血管成像(MRA)、DWI、MRS和CASL-PWI的影像资料。结果病灶呈片状不对称分布脑实质,以颞叶、顶叶、枕叶较多;MRI T1序列稍低信号、T2序列稍高信号,FLAIR、DWI信号较高,ADC图显示信号稍偏低。MRA未见病变相应区域血管异常改变;病变可同时累及Willis两支血管供血区。MRS示病灶区乳酸峰升高,MRI平扫无异常信号的脑组织亦出现乳酸峰轻度升高。CASL-PWI显示病变区高灌注。结论多模态核磁共振检查对诊断成人MELAS综合征极大价值。

Objective To explore the diagnostic value of the combined application of multiple functional magnetic resonance imaging in adult mitochondrial encephalomyopathy with lactate and stroke like episodes(MELAS).Methods One MELAS patient,in addition to CT plain scan and routine MRI examination sequences,was supplemented with imaging data from MR angiography(MRA),DWI,MRS,and CASL-PWI.Results The lesions were asymmetrically distributed in a patchy pattern in the brain parenchyma,with a higher incidence in the temporal,parietal,and occipital lobes;MRI T1 sequence has slightly lower signal,T2 sequence has slightly higher signal,FLAIR and DWI signals are higher,and ADC image shows slightly lower signal MRA did not show any abnormal vascular changes in the corresponding area of the lesion;The lesion can simultaneously affect the blood supply areas of both Willis blood vessels MRS showed an increase in lactate peak in the lesion area,and mild elevation of lactate peak was also observed in brain tissue without abnormal signals on MRI plain scan CASL-PWI shows high perfusion in the lesion area.Conclusion Multimodal magnetic resonance imaging is of great value in diagnosing adult MELAS syndrome.