MRI/~1H-MRS在MELAS综合征与卒中鉴别诊断中的应用研究

目的探讨线粒体脑肌病伴高乳酸血症及卒中样发作(MELAS)综合征头颅磁共振(MRI)及头颅磁共振波谱(~1H-MRS)特点与其早期诊断价值。方法对8例诊断为MELAS综合征患者的MRI及MRS结果进行分析。结果 8例MELAS综合征患者的头颅MRI结果示病变累及多个脑叶,主要包括额叶、颞叶、顶叶、枕叶皮质及双侧基底核、放射冠区,其中4例患者可见不同程度的脑萎缩;头颅磁共振血管造影(MRA)检测均未见颅内动脉异常,且病灶区域与主要供血动脉分布无明显相关性;4例患者头颅~1H-MRS可见病变区域显著Lac峰,以及病灶区NAA峰显著降低。结论头颅~1H-MRS能够为MELAS综合征患者提供无创性检查,分析脑组织能量代谢变化,对MELAS综合征的早期诊断具有重要价值。

Application of MRI/MRS in differential diagnosis of MELAS syndrome and stroke

Objective To explore the magnetic resonance imaging(MRI)and magnetic resonance spectroscopy(1H-MRS)characteristics of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes(MELAS)syndrome and the value of application of MRI/MRS in early diagnosis. Method The results of MRI and 1H-MRS scans were analyzed in 8 patients of MELAS syndrome. Results The results of MRI scan of 8 patients showed that the lesions in the brains were mainly located in frontal lobe, temporal lobe, parietal lobe, occipital lobe, basal ganglia and corona area, and brain atrophy was found in 4 patients. The results of MRA indicated that there were no intracranial macroangiopathy, and the lesions were not distributed in accordance with cerebral vessels. The results of 1H-MRS in the brains of 4 patients showed increased lactate peak and reduced N acetyl aspartate(NAA) peak in the lesions. Conclusion Brain MRI/1H-MRS was an important noninvasive method to analyze the variation of energy metabolism, which played an important role in the early diagnosis of MELAS syndrome.