磁共振诊断肾移植后合并脑后部可逆性脑病综合征四例

目的 探讨磁共振成像(MRI)在肾移植术后合并脑后部可逆性脑病综合征(PRES)诊断中的应用.方法 4例患者,均为女性,平均年龄为41.7岁,肾移植后使用环孢素A(或他克莫司)、霉酚酸酯和糖皮质激素预防排斥反应,其中1例于术后第2天采用抗淋巴细胞球蛋白.PRES的起病时间为术后4～17 d,平均为10 d,患者均于起病后2 d内进行MRI检查.结果 MRI结果提示,PRES病变累及顶叶4例,枕叶3例,额叶2例,小脑2例,桥脑1例,基底节区1例,病变占位效应均不明显.顶枕叶、额叶病变位于皮层下白质,其中1例累及皮质,为双侧大致对称性分布的斑片状影.病变区T1WI呈低、等信号,T2WI及冠状位液体衰减反转恢复(FLAIR)像呈高信号.3例磁共振扩散加权成像(DWI)呈等信号,1例呈略低信号;4例表观扩散系数(ADC)图均表现为高信号,其中1例病变周边DWI表现为高信号,ADC图为等信号.结论 肾移植术后合并RPES的MRI表现较具特征性,特别是DWI及ADC图,有助于疾病的早期诊断.

Diagnosis of posterior reversible encephalopathy syndrome after kidney transplantation by MRI:a report of 4 cases

Objective To investigate the application of MRI in the diagnosis of posterior reversible encephalopathy syndrome(PRES)after kidney transplant.Methods All 4 patients with PRES after kidney transplants were female,with mean age of 41.7 years.Ciclosporin A(or tacrolimus),mycophenolate mofetil and glucocorticoids were used for preventing reject reaction in all patients after kidney transplant,and anti-lymphocyte globulin was used on the second day after operation in one case.Onset time of PRES was 7-10 days(mean 10 days),and MRl was performed in 2 d after onset.Results MRI showed that parietal lobe was involved in 4 cases,occipital lobe in 3 cases,frontal lobe in 2 cases,cerebellum in 2 cases,pons in one case,and basal nucleus in one case.There was no obvious space-occupying effect in lesions.The lesions in the occipital,parietal lobes and frontal lobe were situated in subcortical white,one of which cortex was involved.MRI showed that the lesions were distributed with plaque shape and bilaterally symmetry.The lesions were hypo-,isointense on T1 weighted.and hyperintense on T2 weighted and fluid-attenuated inversion recovery (FLAIR)imaging,respectively.On diffusion-weighted imaging(DWI),the lesions appeared as isointense in 3 cases and hypointense in one case.On apparent diffusion coefficient(ADC)map,all of the lesions were hyperintense.The surrounding of the lesion in one case was hyperintense in DWI,and isointense in ADC map.Conclusion PRES after kidney transplant has characteristic MR findings,especially on DWI and ADC map,which is helpful for us to make the early diagnosis of PRES.