可逆性后部脑病综合征患者CT及MRI影像学表现及临床诊疗价值

CT and MRI Imaging Manifestations and Clinical Diagnosis and Treatment Value of Patients with Reversible Posterior Encephalopathy Syndrome

目的分析可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)患者电子计算机断层扫描(computed tomography,CT)、核磁共振成像(magnetic resonance imaging,MRI)影像学表现特征;并绘制风险预测模型。方法对我院2022年1月~2023年8月收治的PRES患者42例临床资料进行分析。同时选取我院收治的可逆性脑血管收缩综合征(reversible cerebral vasoconstriction syndrome,RCVS)患者40例及同期正常体检患者40例为对照组。分析患者CT及MRI影像特征,分析两类检查方法对该病的诊断预测价值。结果单因素分析结果显示:CT双侧额顶枕叶多发片状低CT密度灶、CT左右对称、CT病灶边界、MRI双侧顶枕叶信号、MRI基底节区信号、MRI额叶信号、MRIT1WI病灶信号、MRIT2WI病灶信号在PRES、RCVS、正常者中存在统计学差异(P<0.05)。进一步分析结果显示:有CT双侧额顶枕叶多发片状低CT密度灶、CT左右对称、CT病灶边界、MRI双侧顶枕叶信号异常、MRI基底节区信号异常、MRIT2WI病灶信号底信号是PRES患者病灶主要影响因素(P<0.05)。通过回归系数得出两项联合的数值,经过统计分析得出联合数据。进一步ROC曲线显示,CT、MRI的诊断AUC为0.884、0.887,敏感度、特异度分别为78.6%、87.5%,76.2%、85.0%,联合预测AUC为:0.982、敏感度、特异度分别为:92.9%、92.5%。结论CT、MRI对可逆性后部脑病综合征诊断预测具有一定价值。但为避免单一检测的局限性,建议临床结合患者症状及其他检查手段,进行综合评估。

Objective To analyze the imaging features of computerized tomography(CT)and Magnetic resonance imaging,(MRI)in patients with reversible posterior encephalopathy syndrome(PRES).And draw a risk prediction model.Methods The clinical data of 42 patients with PRES admitted in our hospital from January 2022 to August 2023 were analyzed.At the same time,40 patients with reversible cerebrovascular contraction syndrome(RCVS)admitted to our hospital and 40 patients with normal physical examination in the same period were selected as the control group.To analyze the characteristics of CT and MRI images of patients,and to analyze the diagnostic and predictive value of two kinds of examination methods for this disease.Results The results of univariate analysis showed that there were multiple flaky low CT density lesions in bilateral frontal and occipital lobes on CT,bilateral symmetry on CT,CT lesion boundary,bilateral parietal and occipital lobes on MRI,MRI basal ganglia signal,MRI frontal lobe signal,MRIT1WI lesion signal and MRIT2WI lesion signal,which were statistically different among PRES,RCVS and normal subjects(P<0.05).The results of further analysis showed that the main influencing factors of PRES patients'lesions were multiple patches of low CT density lesions in bilateral frontal,parietal and occipital lobes,symmetry of CT,boundary of CT lesions,abnormal signal in bilateral parietal and occipital lobes on MRI,abnormal signal in basal ganglia on MRI,and signal at the bottom of lesions on MRIT2WI(P<0.05).Two joint values are obtained by regression coefficient,and joint data are obtained by statistical analysis.Further ROC curve showed that the diagnostic AUC of CT and MRI were 0.884 and 0.887,and the sensitivity and specificity were 78.6%,87.5%,76.2% and 85.0% respectively.The joint prediction AUC was 0.982,and the sensitivity and specificity were 92.9 %and 92.5% respectively.Conclusion CT and MRI are valuable in the diagnosis and prediction of reversible posterior encephalopathy syndrome.However,in order to avoid the limitation of single test,it is suggested to make a comprehensive evaluation by combining the symptoms of patients and other examination methods.