摘要
目的:可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)是一种少见的临床-影像综合征。其病因复杂多样,发病机制尚不明确,起病急,发病年龄跨度大,可从儿童到老年人,且临床症状无显著特异性,可表现为头痛、视物模糊、意识障碍、癫痫发作。若临床医师对该病缺少认识容易造成误诊或漏诊。本研究旨在分析并总结RPLS患者的磁共振影像变化及临床特点,以期为迅速诊断、及时干预该病提供依据。方法:回顾性分析2012年1月至2021年3月于中南大学湘雅医院诊断为RPLS的77例患者的临床及影像学资料。主要影像学资料包含T1加权成像(T1 weighted image,T1WI)、T_(2)加权成像(T_(2) weighted image,T_(2)WI)、T_(2)液体衰减反转恢复(T_(2)-fluid attenuated inversion recovery,T_(2)-FLAIR)、扩散加权成像(diffusion weighted imaging,DWI)(b值=1000×10^(−6) mm^(2)/s)、表观扩散系数(apparent diffusion coefficient,ADC)。病例组为行DWI检查的患者63例,招募年龄与性别相匹配的正常对照71例(对照组)。分析患者磁共振信号特点,并测量19个感兴趣区(regin of interenst,ROI)的ADC值。分别比较病例组治疗前脑组织左右两侧、病例组与正常对照组以及病例组中21例患者治疗前后不同ROI的ADC值差异。结果:与对照组相比,病例组右侧额叶、双侧顶叶、双侧丘脑、双侧尾状核头、左侧豆状核、右侧内囊、双侧颞叶及脑桥的ADC值均显著增高(均P<0.01);病例组在治疗前脑组织左右两侧ADC值、病例组治疗前后ADC值变化差异无统计学意义(均P>0.01)。RPLS病变分布广泛、多发,常为大脑后部顶叶、颞叶、枕叶或脑桥高信号,可累及皮层及皮层下白质,且多为双侧,但并不完全对称。结论:RPLS的影像学表现与临床症状的发生、发展过程是基本同步的,影像学表现具有特异性,且磁共振能显示RPLS病变受累范围,ADC值可提供病变严重程�
Objective:Reversible posterior leukoencephalopathy syndrome(RPLS)is a rare clinical imaging syndrome.The causes of RPLS are complex and diverse,the pathogenesis is not yet clear.The onset is urgent and the onset age span is large,ranging from children to the elderly.The clinical symptoms of RPLS have no significant specificity,which can be manifested as headache,blurred vision,disturbance of consciousness or seizures.Clinicians have little knowledge on the disease,which may lead to misdiagnosis or missed diagnosis.This study aims to analyze and summarize the MRI changes and clinical characteristics regarding RPLS patients,so as to provide basis for rapid diagnosis and timely intervention for this disease.Methods:The clinical data and complete imaging data of 77 patients with RPLS diagnosed in Xiangya Hospital of Central South University from January 2012 to March 2021 were retrospectively collected.The main image data include T_(1) weighted imaging(T_(1)WI),T_(2) weighted imaging(T_(2)WI),T_(2) liquid attenuation inversion recovery(T_(2)-FLAIR),diffusion weighted imaging(DWI)(b value=1000×10^(−6) mm^(2)/s),and apparent diffusion coefficient(ADC).The case group included 63 patients who underwent DWI examination,and 71 normal controls matched in age and sex.The characteristics of patients’magnetic resonance signals and the ADC value of 19 regions of interest(ROI)were analyzed.The differences in bilateral ADC value in the case group,the difference of ADC value between the case group and the normal control group,and the difference of ADC value in the case group before and after treatment were compared.Results:Compared with the normal control group,the ADC value of the right frontal lobe,bilateral parietal lobe,bilateral thalamus,bilateral head of caudate nucleus,left lenticular nucleus,right internal capsule,bilateral temporal lobe and pons in the case group were significantly higher(all P<0.01).There was no significant difference in ADC value of bilateral sides of the case group and before and after treatment i
作者
崔学飞
金虹
方越
杨帅
邢妩
CUI Xuefei;JIN Hong;FANG Yue;YANG Shuai;XING Wu(Department of Radiology,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2022年第12期1673-1682,共10页
Journal of Central South University ：Medical Science
基金
湖南省自然科学基金(2019JJ40495)。
关键词
可逆性后部白质脑病综合征
磁共振
表观扩散系数
reversible posterior leukoencephalopathy syndrome
magnetic resonance
apparent diffusion coefficient
