延髓脑梗塞MRI诊断

MRI of the Medulla Oblongata Infarction

目的 :探讨延髓脑梗塞MRI特点。材料和方法 :搜集具有延髓及其后组颅神经损害为主要临床症状的MRI资料 2 6例。采用ElscintGyrexV型磁共振机 ,0 5T ,超导型。SE ,横断位 ,T1 WI (4 0 0 /2 5ms) ,T2 WI (2 2 0 0 /90ms) ,计 2 6例 ;其中 5例加扫冠状位 ,T1 WI (4 0 0 /2 5ms) ;2例进行了MR增扫。结果 :(1 )延髓脑梗塞常偏侧发生 ,左 1 2例 ,右 1 1例 ,中央 3例 ,(2 )病灶最小 3mm ,最大 2 2mm ,平均 1 0 5mm ,占 6 9% (1 8/2 6 ) ;(3)病灶呈类圆形 7例 ,斑片状 1 2例 ,小点状 7例 ;(4 )病灶边缘清楚 5例 ,不清楚 2 1例 ;(5 )病灶区T1 WI呈低信号 2 0例 ,等信号 6例 ,T2 WI呈高信号 2 6例 ;(6 )延髓外形无肿大 1 9例 ,局限肿胀 5例 ,局限萎缩 2例 ,(7)MR增扫 2例均无强化 ;(8)其它改变 ,伴桥脑梗塞 5例 ,小脑梗塞 3例 ,大脑半球及底节梗塞 8例 ,额顶叶脑白质脱髓鞘病变6例。结论 :延髓脑梗塞MRI具有以局限于一侧或一部分损害为主 ,居中央或弥漫者少见 ;以横断位T2 WI最敏感 ,据此可提示其病灶部位、形态、大小、范围等 ;冠状位可显示病灶的上下范围 ,补充横断位不足 ;病灶MRI表现与临床症状的轻重具有相关性 。

Obiective:To analyse MRI features of 26 cases with the medulla oblongata infarction,in order to improve the diagnotic level of the medulla oblongata infarction in MRI.Materials and methods:there were 26 cases of the medulla oblongata infarction associated with clinical symptoms of posterocranial nerves damaged.With Elscint Gyrex V MR system,0 5 Tesla.SE sequence,axial view,T 1 WI(400/25ms),T 2WI(2200/90ms)in 26 cases,and coronal view,T 1(400/25ms)in 5 cases,Gd DTDA enhancement MR in 2 cases.Results:MRI findings as following∶(1)position,left side in 12 cases,right side in 11 cases,and center in 3 cases;(2)size,minimal 3mm,maximun 20mm,and mean 10 5mm(69%,18/26);(3)Shape,Oval like in 7 cases,Piece spot in 12 cases,and small point in 7 cases;(4)Margin,clear in 5 cases,and Vagueness in 21 cases;(5)signal intensity,hypointensity in 20 cases,isointensity in 6 cases,on T 1WI;hyperintensity in 26 cass,on T 2WI;(6)Enlargement of the medulla oblongata,no enlargement in 19 cases,local enlargement in 5 cases,and local atrophy in 2 cases;(7)No enhancement in 2 cases,on Gd-DTPA enhanced MR;(8)Others,Pons infarction in 5 cases,cerebellar infarction in 3 cases,cerebral hemisphere or base ganglion infarction in 8 cases,and leukoencephalopathy in 6 cases.Conclusions:The medulla oblongata infarction caused by impaired blood supply of vertebrabase artery was mainly local or localiged to one side,but diffuse or centrat type was rare.The medulla oblongata infarction was sensitive on T 2WI.MRI feature was strictly correlated with the clinical appearance,the different MRI findings may be mapped to the different clinical symptom,and MRI may be one of the important method in diagnosis of the medulla oblongata infarction.