软脑膜异常强化的MRI表现及其诊断价值

目的:分析不同性质软脑膜病变的MRI表现,探讨其诊断价值。方法:回顾性分析38例软脑膜病变的增强MRI表现,其中软脑膜转移17例,感染性脑膜炎15例,脑梗塞5例,Sturge-Weber综合症1例,所有病例均经手术、临床和实验室检查证实。结果:软脑膜转移中结节样强化12例、弥漫对称性细线样强化12例,其中7例二者并存,未见粗线样或局灶性强化,除5例脑内伴转移瘤所致脑实质异常外,其余12例脑实质未见异常;感染性脑膜炎中线样强化14例,其中细线样及粗线样强化各7例,1例粗线样强化伴结节样强化,局限性、弥漫性强化分别为8例和7例,软脑膜邻近脑实质单纯性水肿者8例;脑梗塞中5例均表现为梗塞灶邻近软脑膜细线样强化,1例Sturge-Weber综合症表现为软脑膜粗线样强化,邻近脑实质萎缩。结论:MRI是检出软脑膜病变敏感和有效的方法,不同性质病变的软脑膜强化具有一定的特点,可为临床诊断、鉴别诊断和治疗提供线索。

Abnormal enhanced MRI findings of leptomeninges and their diagnostic value

Objective:To analyze enhanced MR imaging findings of different leptomeningeal disease and discuss enhanced-MRI value in their diagnosis.Methods:MR imaging manifestation of 38 patients with leptomeningeal disease were retrospectively reviewed.There were 17 cases with leptomeningeal metastasis,15 cases with infectious meningitis,5 cases with cranial infarct,and one Sturge-Weber syndrome.All were confirmed by operation,clinic and laborotary examination.Patterns and distribution of leptomeningeal enhancement were analyzed.Results:The leptomeningeal enhancement in 12 of 17 patients with metastasis appeared as nodular pattern,while 12 cases appeared as diffused fine linear pattern.There were 7 cases with the two enhancement patterns,and 5 cases complicated with cranial parenchyma involvement.Among the 15 cases with infectious meningitis,there were 14 cases wtih linear enhancement,including 7 cases with fine linear enhancement and 7 cases with thick linear enhancement respectively.Eight cases with focal enhancement and 7 cases with diffused enhancement were observed.Adjacent parenchyma edema occurred in 8 cases.All 5 cases with cranial infarct appeared as fine linear leptomeningeal enhancement adjacent to lesions.The one case with Sturge-Weber syndrome manifested as thick linear enhancement with parenchyma atrophy.Conclusion:MRI is sensitive and effective approach to detect leptomeningeal diseases,leptomeningeal enhancement of different causes has relative characteristic.It's helpful for diagnosis,differentiation and management.