海洛因海绵状白质脑病的CT和MR表现

目的：总结海洛因海绵状白质脑病的CT及MRI特征。方法：分析5例海洛因海绵状白质脑病的临床特点，影像表现及1例病理所见，总结其CT和MRI的诊断要点。结果：海劣因海绵状白质脑病的CT和MRI特征为：（1）病变广泛累及小脑，大脑白质及脑博干，内囊后肢，多以小脑损害为重，其中以小脑中线两侧对称性边界清楚的类圆形蝴蝶样病灶为特征。（2）病灶双侧对称，边界清楚；（3）CT示病灶为低密度。MRI示病灶为T1WI低信号以及T2WI高信号影；（4）增强病灶无强化。主要的病理改变为脑白质的空泡样变性。结论：海洛因海绵状白质脑病的CT和MR表现为特征性改变，有海洛因烫吸史者，一旦出现小脑受损的表现，应及早行头部影像学检查明确诊断。

CT and MR imaging of spongiform leukoencephalopathy after heroin vapor inhalation

Objective To summarize the CT and MRI features of spongiform leucoencephalopathy after heroin vapor inhalation. Methods The clinical characteristic, CT,and MRI of 5 cases and biopsy of 1 case with heroin vapor inhalation induced spongiform leukoencephalopathy were analyzed. Results CT and MRI appearances of spongiform leucoencephalopathy after heroin vapor inhalation were as followes: (1) Brain CT and MRI showed extensive symmetrical white matter lesions within bilateral cerebral and cerebellar hemispheres, the brainstem, and posterior limbs of the internal capsule. The cerebelllum was heavely impaired.The most outstanding characteristics of the lesion was ring-like or butterfly-like in shape with clear margin in cerebellar hemispheres. (2)The lesion was bilateral and symmetrical. The margin of the lesion was clear. (3) A computed tomographic scan showed hypointense lesions. T 1-weighted magnetic resonance imaging (MRI) showed hypointense lesions and T 2-weighted MRI showed hyperintense lesions. (4)No enhanecment with Gd-DTPA was revealed. (5) Spongiform vacuoles degeneration of white matter was the main morphological change by biopsy. Conclusion Spongiform leukoencephalopathy should be considered if a patient showed acute cerebellar signs who had a history of inhaling heroin pyrolysate. The imaging manifestation of this disease is typical and the diagnosis can be made by head CT or MRI.