46例CO中毒脑病病例脑部MRI影像特征及ADC值分析

目的探讨急性一氧化碳中毒(ACOP)脑病患者脑部MRI影像特征及弥散加权成像表观弥散系数(ADC)值分析的临床价值。方法回顾性分析46例急性CO中毒迟发性脑病(DEACMP)患者(观察组)及30例健康志愿者(对照组)脑部MRI影像及临床资料,分析其影像特征。对比两组受试者皮质区、半卵圆中心区、侧脑室周围白质区、苍白球区等相同部位的ADC平均值差异。结果 46例观察组受试者中15例(32.6%)MRI影像表现正常(无重度ACOP者,轻度14例、中度1例);剩余31例受试者头颅MRI影像可见异常信号,其中大脑皮质区受累2例,双侧顶叶皮质区可见T1WI对称性低信号、T2WI及DWI呈对称性高信号;双侧苍白球区异常信号者19例,表现为对称性长T1、长T2信号,呈现典型的"熊猫眼"特征;双侧脑白质区异常信号者10例,MRI图像可见对称分布的斑片状异常信号影,T1WI呈稍低信号,T2WI呈稍高信号,脑沟及脑裂均未见异常。观察组皮质区、半卵圆中心区、侧脑室周围白质区、苍白球区等部位ADC平均值均显著低于对照组,差异具有统计学意义(P0.05)。结论 MRI在DEACMP的临床诊断中具有明显的影像特征,联合ADC值评估可有效提高诊断准确性,为后续诊疗工作的顺利开展提供条件。

MRI Features and ADC Values of Brain Samples in 46 Cases of CO Poisoning Encephalopathy

Objective To investigate the brain MRI features of patients with acute carbon monoxide poisoning encephalopathy (ACOP) and the clinical value of analyzing apparent diffusion coefficient (ADC) value.Methods The brain MRI imaging and clinical data of 46 cases of patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) (the observation group) and 30 cases of healthy volunteers (the control group) were retrospectively analyzed. The imaging features were analyzed. The differences of ADC average values on the same sites in cortical areas, centrum semiovale, periventricular white matter and globus pallidus areas were compared.Results Among 46 subjects in the observation group, the MRI findings of 15 cases (32.6%) were normal (no patients with severe ACOP, 14 mild cases, 1 moderate cases). The MRI findings of the other 31 subjects showed abnormal signal, including 2 cases of cerebral cortex involvement. There existed symmetrical low signal in on bilateral parietal cortex on T1WI and symmetrical high signal on T1WI and DWI. 19 cases showed abnormal signal in the bilateral globus pallidus area, showing symmetrical long T1 and long T2 signal, with typical panda eyes features;10 cases showed abnormal signal in bilateral cerebral white matter area. MRI showed symmetrical distribution images of patchy abnormal signal shadow, slightly low signal on T1WI and slightly high signal on T2WI. There were no abnormalities in cerebral sulcus and cerebral fissure. The mean values of ADC in the cortical areas, centrum semiovale, periventricular white matter and globus pallidus areas of the observation group were significantly lower than those of the control group(P<0.05).Conclusion MRI has obvious imaging characteristics in the clinical diagnosis of DEACMP. Its combination with ADC value in assessment can effectively improve the accuracy of diagnosis, and provide conditions for the smooth development of the follow-up diagnosis and treatment.