系统性红斑狼疮中枢神经系统病变的MRI研究

The MRI Studies of the Central Nervous System Disorders of Systemic Lupus Erythematosus

目的 探讨系统性红斑狼疮脑病的MRI表现。方法 14例系统性红斑狼疮病人出现脑部症状后 1～ 3天内 (活动期 )及病情稳定后 (静止期 )行颅脑MRI检查 ,并分析MRI表现。结果 (1)活动期MRI表现 :8例 (A组 )T2WI呈现较大的或许多点状大小的高信号 ,多分布于深部脑白质 ,T1加权图像不明显 ,亦无对比增强。 3例 (B组 )T1WI和T2WI信号接近 ,强化明显 ,病灶较大 ,边界欠清 ,主要分布在额叶 ,颞叶 ,小脑 ,皮层下白质及深部白质。 3例 (C组 )额叶 ,枕叶 ,桥脑T2WI显示高信号病灶 ,T1WI表现相应部位低信号 ,3组相比 ,P <0 .0 1。 (2 )静止期MRI表现 :与活动期相比 ,3组静止期病灶皆缩小 ,边界清晰 ,T1WI信号降低 ,T2WI信号升高 ,强化减弱 (A组P <0 .0 1,B组与C组P <0 .0 5。结论 系统性红斑狼疮性神经系统病变形式多样 ,颅脑MRI对SLE脑病有较高敏感性 ,结合临床可以早期确诊并指导临床治疗。

Objective To study the clinical and MRI manifestations of the central disorders of the system lupus erythematosus. Methods We systematically analyzed 51 SLE patients dating from Oct.1980 to Oct.2000 who had central nervous system manifestations, 28 patients had brain symptoms, 14 patients undergo MRI in 1～3 days after appearing of the central symptoms (active phase) and in resting phase. Results (1) MRI manifestations in active phase : 8 cases(A group)present large spot or dot-like high signals on T2WI, most focuses locate in deep white matter, On T1WI images the focuses were not obvious and no contrast enhansement.3 cases(B group) with large focus locate in front lobe, temporal lobe cerebellum sub and deep white matter, the signal intensity were nearly equal on T1WI and T2WI, with obvious enhancement. 3 cases (c group) appears as high signal on T2WI and low signal on T1WI, the focuses mainly distribute on frontal lobe, occipital lobe and pons. The statistical difference between three groups is obvious (P<0.01). Resting phase: comparing with the active phase, all the focuses become smaller and the boundary become clear, the signal become low on T1WI and high on T2WI, and the enhancement is less so obvious (A group P<0.01,B and C group P<0.05). Conclusions The central nerves manifestations of SLE were diversified , MRI is sensitive in finding the encephalopathy of SLE, it can be used to diagnose the early disease and to evaluate the treatment.