MRI对可逆性后部脑病综合征的诊断价值

发布时间：2018-03-31 09:47

  本文选题：磁共振成像　切入点：可逆性后部脑病综合征　出处：《河北医科大学》2014年硕士论文

【摘要】：可逆性后部脑病综合征(Reversible Posterior Encephalopathy Syndrome. RPES)症状体征进展迅猛,双侧大脑半球后部白质发生可逆性病变为其典型影像表现,其性质为血管源性水肿。大多数患者血压明显高,或者患有一些基础疾病,MRI为诊断RPES的重要检查方法,DWI及ADC序列能鉴别脑部发生缺血性病变的细胞毒性水肿与RPES的血管源性水肿。若诊断和治疗及时,症状及影像学异常可完全恢复正常；如果延误诊治,将会导致持久的神经功能障碍,甚至死亡。目的：旨在探讨可逆性后部脑病综合征(RPES)磁共振表现特点及ADC值的变化从而来评价其临床应用价值,从而提高临床医生认识RPES,并做到早期诊断、正确识别及早期治疗方法：收录2011年1月-2014年1月期间30例MRI检查确诊患者,回顾性分析其MRI特点。测得30例RPES患者病变区域的ADC值,归为病变组,同时与之相匹配的是年龄、性别均相同的健康志愿者,测得其相对应部位的ADC值,纳入对照组,将这两组进行比较。结果：1本组30例患者中男性9例,女性21例,女性比例偏高。最常见病因为高血压病和妊娠高血压子痫或子痫前期,继发于妊娠高血压17例(60.3%),高血压病7例(23.3%)；其他病因为系统性红斑狼疮1例,过敏性紫癜1例,肾病综合征3例,另发现干燥综合征1例。2发病急,血压常在急性期出现显著增高,少数轻微升高或正常,其临床表现为以头痛、癫痫,意识障碍,视力障碍四联征最常见。3影像学表现：30例患者均行常规MRI扫描、DWI、ADC、MRA及MRV扫描,显示顶叶28例(93.3%)均受累,同时伴枕叶受累26例(86.7%),后循环其他部位也可受累,如小脑6例(20%)、中脑及桥脑4例(13.3%),胼胝体1例(3.3%)。除后循环外,前循环也可受累,如额颞叶10例(33.3%)、基底节区5例(16.7%)、丘脑4例(13.3%)及脑室旁白质3例(10%),绝大多数病变在枕叶,上述部位亦可累及。RPES的磁共振影像学特征主要表现为大脑后部皮层及皮层下对称性病灶,T1WI呈等或略低信号,T2WI及FLAIR序列上呈高信号,FLAIR高信号更为明显；DWI呈等信号或稍低信号,ADC图呈高信号；病变组ADC值为0.712-1.256×10-3mm2/s,平均值为1.116×10-3mm2/s,而对照组ADC值则为0.623-0.83610-3mm2/s,平均为0.726×10-3mm2/s,对照组ADC值低于病变组,P值为0.043,差异有统计学意义(P0.05)。本组30例经治疗(2周)后复查MRI,8例病变较前明显减少,22例完全消失。4本病明确诊断需通过其临床特有表现和MRI独特表现,加上症状、体征及影像学在经过2周治疗后恢复正常或明显好转。应紧密观察患者的发病史、既往史、临床症状、腰穿以及实验室检查,有时需要结合治疗和转归等。结论：RPES主要临床症状为头痛、头晕、癫痫发作、意识障碍、视觉障碍。其常见病因为高血压脑病及妊娠高血压征子痫或子痫前期。磁共振影像学特征主要表现为大脑后部皮层及皮层下出现对称性T1低信号,T2高信号,长FLAIR信号更为显著；等或略低DWI信号,ADC图呈显示高信号,测量病变组及对照组ADC值变化,病变组明显比对照组高。经过治疗后临床症状和磁共振影像学特征可以完全恢复正常,说明一般预后良好,若诊治不及时,则可以造成不可逆性神经功能损害。
[Abstract]:Posterior reversible encephalopathy syndrome (Reversible Posterior Encephalopathy Syndrome. RPES) symptoms and signs of rapid progress, bilateral posterior cerebral hemisphere white matter occurrence of reversible disease is the typical manifestations of the nature of vasogenic edema. Most patients with high blood pressure significantly, or suffering from some diseases, MRI is an important method for diagnosis of RPES, DWI and the ADC sequence can vasogenic edema and cytotoxic edema in ischemic brain RPES in the differential diagnosis of lesions. If timely diagnosis and treatment can be completely restored to normal, abnormal symptoms and imaging studies; if the delay in treatment, will lead to permanent neurological dysfunction, and even death. Objective: To study the posterior reversible encephalopathy syndrome (RPES) the change characteristics and the value of ADC MRI to evaluate its clinical application value, so as to improve clinician awareness of RPES, and achieve the early diagnosis , correct identification and early treatment methods: during the period January 2011 -2014 year in January included 30 cases of MRI diagnosed patients were retrospectively analyzed. The characteristics of MRI measured in 30 patients with RPES, the ADC values of lesions, classified as lesion group, and matched the age, gender were the same in healthy volunteers, measured the the corresponding part of the value of ADC in the control group, the two groups were compared. Results: the 1 group of 30 patients, male 9 cases, female 21 cases, the high proportion of women. The most common disease because of hypertension and gestational hypertension or preeclampsia eclampsia, 17 cases of hypertension secondary to pregnancy (60.3%), 7 cases of hypertension (23.3%); 1 cases of other diseases because of systemic lupus erythematosus, 1 cases of allergic purpura, 3 cases of nephrotic syndrome, the other found Sjogren syndrome in 1 cases of.2 acute onset, blood pressure often appear in the acute period increased significantly, a slightly elevated or normal, the clinical manifestation is to head 鐥，

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