MSCT及3.0TMRI诊断可逆性后部白质脑病综合征的临床意义

目的:探讨可逆性后部白质脑病综合征(RPLS)的MSCT、MRI影像学表现及临床意义。方法:对15例诊断为RPLS患者的临床及影像学资料作一回顾性分析。结果:RPLS病灶主要分布于双侧大脑后部皮质下脑白质,MRI表现为T2WI及FLAIR高信号,MSCT表现为脑皮质下低密度影,部分患者扩散加权成像(DWI)高信号。15例累及双侧大脑半球,其中枕叶受累14例(93.3%),顶叶受累15例(100.0%),额叶受累14例(93.3%),颞叶受累9例(60.0%),3例累及两侧基底节区(20.0%),3例累及右侧基底节区(20.0%),同时3例累及小脑(20.0%)、1例累及脑干(6.7%)、2例累及胼胝体(13.3%)。13例患者接受DWI,其中13例(100.0%)DWI上部分呈等、高信号,6例(46.2%)部分病灶表现扩散系数图呈低信号。MR静脉成像3例、MR动脉成像2例均未见脑动脉及脑静脉异常。MRI显示病灶较MSCT更清楚、累及范围更多,尤其在FLAIR序列上的显示。13例患者经治疗后病灶均有明显好转、甚至消失,1例诊断治疗不及时,多次复查后发现右侧颞枕顶叶软化灶形成。结论:RPLS一般预后良好,有较特征的影像学改变,尤其以MRI表现为主,内科医生应认识RPLS的影像学特征,早期诊断、治疗,可避免造成永久性神经损伤后遗症。

The clinical significance of MSCT and 3 . 0 T MRI in the diagnosis of reversible posterior leukoencephalopathy syndrome

Objective:To evaluate the imaging manifestations and clinical significance of MSCT and MRI in the reversible posterior leukoencephalopathy syndrome(RPLS). Methods:The clinical and imaging data of 15 RPLS patients were retrospectively analyzed. Results:The RPLS lesions located mainly in bilateral posterior subcortical white matter, the manifestation of MRI was the hyperintensities of T2WI and FLAIR. The manifestation of MSCT was the subcortical low density shadow,and the diffusion-weighted images( DWI) in part of lesions were hyperintensities. The lesions of bilateral cerebral hemisphere involved in 15 cases,which included 14 cases(93. 3%) in occipital lobe,15 cases(100. 0%) in parietal lobe,14 cases(93. 3%) in frontal lobe,9 cases(60. 0%) in temporal lobe,3 cases(20. 0%)in bilateral basal ganglia region and 3 cases(20. 0%) in the right side of the basal ganglia region. Three cases(20. 0%) in cerebellum,1 case(6. 7%) in brain stem and 2 cases(13. 3%) in corpus callosum were identified. Among 13 patients detected by DWI,the upper DW1 of 13 cases(100%) were isoheight and high signal. The apparent diffusion coefficient(ADC) mapping of part of lesions in 6 cases were low signal. The abnormal cerebral artery and vein imaging in 3 cases of MR venography and 2 cases of MR artery angiography were not found. Compared with MSCT,the imaging of MRI could clearly show the lesions,and involve more scope,especially in showing the FLAIR sequence. The lesions in 3 cases were significantly improved after treatment, and even disappeared. The softening lesions in the right temporooccipital parietal lobe of 1 case was found because of delayed diagnosis. Conclusions:The prognosis of RPLS is usually benign, and RPLS has the characteristical imaging change, particularly in MRI performance. The imaging characteristics of PRLS should be awared, the early diagnosis and treatment can aviod the permanent neurological sequlae.