MRI常规扫描在儿童烟雾病的诊断价值

Diagnostic Value of Conventional MRI in Pediatric Moyamoya Disease

目的探讨儿童烟雾病(MMD)MRI常规扫描的影像学表现,提高对该疾病的认识。方法回顾性分析24例经DSA证实为MMD患儿的MRI资料,观察病例的影像学表现,采用趋势卡方检验对不同分期的各异常指征进行趋势分析。结果双侧21例,单侧3例,共45侧。常规扫描发现大脑中动脉水平段(M1段)纤细38侧(84.4%);基底节区异常小血管26侧(57.8%);T2-FLAIR显示“常春藤征”36侧(80.0%)、显示“髓质条纹征”38侧(84.4%);大脑白质显示斑片状T2WI高信号病灶23侧(51.1%)、软化灶5侧(11.1%);急性皮层梗死11侧(24.4%)、局部皮质萎缩10侧(22.2%)。M1段纤细和“髓质条纹征”的发生率在不同分期存在显著差异(P<0.05),其他异常指征的发生率在不同分期的差异无统计学意义(P>0.05)。结论MMD患儿患侧M1段多狭窄,基底节区可见异常小血管形成,患侧大脑T2-FLAIR可表现“常春藤征”和“髓质条纹征”,白质可存在局限性缺血灶或软化灶,皮层可伴急性梗死或软化、萎缩。MRI常规扫描可对儿童MMD的检出提供重大诊断依据。

Objective To investigate the imaging manifestations of moyamoya disease in children by conventional MRI and to improve the understanding of the disease.Methods The MRI data of 24 children with moyamoya disease confirmed by DSA were retrospectively analyzed.The imaging manifestations of the cases were observed,and chi-square test was used to analyze the trend of abnormal indications in different stages.Results There were 21 bilateral cases and 3 unilateral cases,a total of 45 sides.Conventional scan revealed 38(84.4%)slender horizontal segments of the middle cerebral artery;abnormal small vessels were found in 26 sides(57.8%)of basal ganglia.T2-FLAIR showed“ivy sign”in 36 sides(80.0%)and“medullary streaks sign”in 38 sides(84.4%).23 sides(51.1%)of cerebral white matter showed patchy hyperintense lesions on T2 WI,and 5 sides(11.1%)showed malacia foci.There were acute cortical infarction in 11 sides(24.4%)and local cortical atrophy in 10 sides(22.2%).There were significant differences in the incidence of M1 segment slender and“medullary streaks sign”in different stages(P<0.05),while there were no significant differences in the incidence of other abnormal indications in different stages(P>0.05).Conclusion In children with moyamoya disease,the M1 segment of the affected side is more slender,abnormal small blood vessels can be seen in the basal ganglia,T2-FLAIR of the affected side of the brain can show“ivy sign”and“medullary streaks sign”,there may be localized ischemia or softening foci in the white matter,and the cortex can be accompanied by acute infarction or softening or atrophy.Conventional MRI can provide important diagnosis for the detection of moyamoya disease in children.