摘要
目的探讨脑桥外髓鞘溶解症(EPM)的MRI和CT表现。方法共收集10例快速纠正低钠血症后出现的EPM,对其临床和影像学资料进行分析。10例患者的低钠血症病因各异,其中腺垂体功能减退症3例,咯血后静滴垂体后叶素2例,肝硬化并消化道出血1例,门静脉海绵样变性并消化道出血1例,肝移植术后1例,肠梗阻1例,慢性腹泻1例。10例患者均行MRI T1WI、T2WI及T2FLAIR扫描,其中有3例行MRI增强扫描,5例行弥散加权成像(DWI)扫描,1例行磁共振波谱分析(MRS),3例行CT扫描。结果 10例患者MRI平扫发现渗透性脱髓鞘病灶累及尾状核8次、豆状核8次、丘脑5次、颞叶3次、顶叶3次、额叶2次、枕叶1次,其中有3例同时累及脑桥;3例增强扫描均未见明显强化;5例DWI扫描均显示与T2WI相对应的斑片状高信号,表观弥散系数(ADC)图上呈等或稍低信号;1例行MRS见N-乙酰基天门冬氨酸(NAA)峰减低,胆碱复合物(Chol)峰未见明显变化,NAA/Chol比值减低,未出现明显乳酸(Lac)峰。3例CT扫描中仅有1例于双侧尾状核及豆状核见低密度,余2例未发现病灶。结论 EPM的CT扫描多有假阴性,MRI为首选检查,常表现为基底节、丘脑或皮层处T1低信号,T2高信号,无占位和强化效应,DWI上表现为高信号,ADC图上呈等或稍低信号,MRS可出现NAA峰减低,NAA/Chol比值减低。
Objective To investigate the characteristics of the MRI and CT images of extrapontine myelinolysis（EPM）. Methods Clinical and imaging data of 10 patients who suffered EPM after rapid correction of hyponatremia were ana- lyzed. Hyponatremia in the 10 patients was caused by hypopituitarism in 3 cases,intravenous injection of hypophysin because of hemoptysis in 2 cases,hepatic cirrhosis complicated with gastrointestinal bleeding in 1 case,cavernous transformation of the por- tal vein complicated with gastrointestinal bleeding in 1 case,liver transplantation in 1 case,intestinal obstruction in 1 case and chronic diarrhea in 1 case. All the ten patients underwent conventional MRI scanning,including T1WI,T2WI and Tz FLAIR se- quences. Among them,CT scanning was performed in 3 patients,enhanced MRI in 3 cases,diffusion-weighted imaging（DWI） in 5 cases and proton magnetic resonance spectroscopy（1 H-MRS） in 1 case. Results MRI scanning showed demyelinating lesions in caudate nucleus in 8 cases,in lenticular nucleus in 8 cases,in thalamus in 5 cases,in temporal lobe in 3 cases,in parietal lobe in 3 cases, in frontal lobe in 2 cases and in occipital lobe in 1 case. Mesocephalon was concomitantly affected in 3 ca- ses. Enhancement was not found in the 3 patients who underwent enhanced MRI. DWI performed on 5 patients showed high patchy signals which corresponded to the low or equal signal intensity on the ADC map. MRS imaging on only 1 patient showed the reduction in NAA signals and the ratio of NAA/Chol,normal Chol peak and unconspicuous Lac peak. CT scanning on 3 pa- tients showed low signal intensities in the bilateral caudate nuclei and lentiform nuclei in only 1 patient and no lesions in the oth- er two patients. Conclusion MRI is the examination of choice for EPM,which often shows the involved lesions in the basal gan- glia,thalamus and cerebral lobes, low signal intensity on T1WI, high signal intensity on T2WI, rare mass effect and enhance- ment. False negative results were frequently found in CT scans. MR
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2013年第2期203-206,共4页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
基金
国家自然科学基金青年基金资助项目(No.81102689)
关键词
脑桥外髓鞘溶解症
脑桥中央髓鞘溶解症
CT成像
MRI成像
extrapontine myelinolysis
central pontile myelinolysis
computerized tomography
magnetic resonanceimaging
