脑部炎性脱髓鞘假瘤MRI表...合临床特征对临床的诊断价值_赵文.pdf

17CHINESE JOURNAL OF CT AND MRI,FEB.2023,Vol.21,No.02 Total No.160【第一作者】赵文，男，副主任医师，主要研究方向，腹盆部核磁共振影像诊断。E-mail：【通讯作者】钱伟军，男，主任医师，主要研究方向：腹盆部核磁共振影像诊断。E-mail：论 著The Clinical Value of MRI Manifestations and Clinical Features of Inflammatory Demyelinating Pseudotumor of the Brain*ZHAO Wen,QIAN Wei-jun*.Department of Imaging,Kaifeng Central Hospital,Kaifeng 475000,Henan Province,chinaABSTRACTObjective The imaging characteristics and clinical characteristics of 50 cases of encephalitis demyelinating Pseudotumor were summarized to improve the imaging and clinical diagnosis level of demyelinating Pseudotumor.Methods The analysis and study of 50 patients confirmed 19 cases of encephalitis-inflammatory demyelinoma after surgical pathology,and 31 cases of inflammatory demyelinoma confirmed by clinical treatment.Results Using GE Silent 1.5T superconducting MRscanner to obtain imaging graphics for 50 patients,MRI examination 30 patients detected a total of 66 lesions were T1WI low signal,T2WI high signal,T2WI lesion center is very high signal shadow,edge slightly higher signal shadow,DWI acute stage,subacute stage lesions high signal shadow,and then the signal gradually reduced,lesions AD.Enhanced scanning of 60 lesions fortification,6 lesions without reinforcement,31 lesions irregular non-closed ring reinforcement(half-moon signs),opening towards the cortical or substrate section gray mass,4 lesions ring strengthening,15 cases of lesions vertical lateral brain chamber flame-like reinforcement and can be seen perpendicular to the enlary vein shadow of the brain chamber,comb-like structure(comb signs),10 lesions irregular patch-like reinforcement,6 lesions without reinforcement.The form of lesions is mainly more than 2cm diameter round,lesions can also be single or multiple.Clinical manifestations are also characteristic;in middle-aged and young people,clinical manifestations are not directly related to the number of lesions in the brain,and the location of lesions is closely related,mainly characterized by headache as the first,vision loss,decreased awareness function,memory loss and other characteristics,no epilepsy symptoms.Conclusion Imaging diagnostic doctors have some research on intra-brain occupied lesions,have a better grasp of typical imaging characteristics,rarely combine clinical characteristics to analyze,there are certain limitations,for imaging characteristics and clinical characteristics of the correspondence is not enough to grasp,This article analyzes the imaging characteristics of 50 patients with intracerebral inflammatory demyelinating pseudotumor combined with clinical features to improve the diagnosis rate of intracerebral inflammatory demyelinating pseudotumor.Keywords:Demyelinating Pseudotumor;The Characteristics of MRI Performance;Clinical Characteristics中枢神经系统脱髓鞘假瘤(DPT)是一种比较特殊的脱髓鞘疾病的类型，病理特点髓鞘脱失和轴索完整，因病灶形态主要为直径大于2cm类圆形，病灶也可以单发或者多发，具有占位效应1-3，无论影像方面、临床表现都与脑肿瘤类似，因此，两者容易混淆，误诊，只要抓住影像特点和临床特征才能提高诊断率。本研究收集50例患者的脑内脱髓鞘假瘤(DPT)MRI影像学特点、临床表现等资料，探讨患者脑内脱髓鞘假瘤(DPT)影像特点及临床特征，以提高脑内炎性脱髓鞘假瘤的诊断4-6。1 资料与方法1.1 资料与方法 方法分析研究50例患者经过手术病理证实脑内炎性脱髓鞘假瘤19例，临床治疗证实炎性脱髓鞘假瘤31例，男性患者26例，女性患者24例，年龄为1654岁，平均年龄为35岁，病程12h-9周，平均病程(2.20.56)周。患者均为急性期、亚急性期发病，首发临床表现为头痛、失语、头疼、头晕、肢体无力、视野缺损，认识功能障碍，视物模糊等7-9。1.2 方法 采用GE Silent 1.5T超导型MR扫描仪，头正交线圈，患者取仰卧位，头先进。常规平扫设置：快速成像序列(TSE)，横断面T1WI、T2WI、FLAIR，DWI矢状位T1WI扫描，冠状位T1WI扫描，层厚 4mm，层间距1mm，FOV20-25，成像矩阵256256。弥散加权成像扫描(DWI)b值为0与1000s/m2。MRI增强扫描：经肘静脉注射造影剂，注射速率2mL/s，行横断、冠状和矢状位T1WI扫描。50例患者均氢质子磁共振波普(1H-MRS)，脑弥散张量成像(DTI)扫描。1.3 统计学方法 采用描述性统计学方法，对本研究结果进行整理。2 结 果2.1 采用GE 1.5T超导型MR扫描仪对50例患者行头颅检查获取影像图像 (1)MRI平扫50例患者检出66个病灶均位于皮层下白质区，灰质及白质交界区，病灶也可以单发或者多发，依次分别为额叶24个病灶、顶叶8个病灶、颞叶15个病灶、侧脑室周围12个病灶、枕叶7个病灶，病灶形态主要为直径大于2cm类圆形，具有轻-中度占位效应。(2)病灶边界：病灶边界模糊不清，具有轻-中度占位效应，38个病灶呈轻度占位效应，28个病灶呈中度占位效应。(3)病灶均呈T1WI低信号、T2WI高信号，T2WI病灶呈中心极高信号影、边缘稍高信号影，DWI急性期、亚急性期病灶高信号影，以后逐渐变低，病脑部炎性脱髓鞘假瘤MRI表现特点结合临床特征对临床的诊断价值*赵 文 钱伟军*河南省开封市中心医院影像科(河南 开封 475000)【摘要】目的 总结50例脑内炎性脱髓鞘假瘤影像特点及临床特征，以提高脑内脱髓鞘假瘤影像及临床诊断水平。方法 分析研究50例患者经过手术病理证实脑内炎性脱髓鞘假瘤19例，临床治疗证实炎性脱髓鞘假瘤31例。结果 采用采用GE Silent1.5T超导型MR扫描仪对50例患者行头颅检查获取影像图形，MRI检查50例患者共检出66个病灶均呈T1WI低信号、T2WI高信号，T2WI病灶中心呈极高信号影、边缘稍高信号影，DWI急性期、亚急性期病灶高信号影，随后信号逐渐减低，病灶ADC值降低。增强扫描60个病灶强化，6个病灶无强化，31个病灶不规则非闭合环状强化(半月征)，开口朝向皮质或基底节区灰质，4个病灶环状强化、15个病灶垂直侧脑室火焰状强化并可见垂直于脑室的扩张静脉影，呈梳齿样结构(梳齿征)，10个病灶不规则斑片状强化、6个病灶无强化。病灶形态主要为直径大于2cm类圆形，病灶也可以单发或者多发。临床表现也具有特征性;中青年多发，临床表现与脑内病灶数的多少没有直接关系，与病灶的位置密切相关，主要表现为头痛为首发、视力下降、认识功能下降、记忆力减退等特征，没有癫痫症状。结论 影像科诊断医生对脑内占位性病变有一定研究，对典型的影像特点掌握的比较好，很少结合临床特征去分析，存在一定的局限性，对于影像特点和临床特征对应关系把握不够，本文通过分析50例脑内炎性脱髓鞘假瘤患者影像特点结合临床特征，以提高脑内炎性脱髓鞘假瘤的诊断率。【关键词】炎性脱髓鞘假瘤；核磁共振表现特点；临床特征【中图分类号】R445.2【文献标识码】A【基金项目】河南省医学科技攻关计划联合共建项 目(LHGJ20191179)DOI:10.3969/j.issn.1672-5131.2023.02.00718中国CT和MRI杂志2023年02月 第21卷 第02期 总第160期（收稿日期：2021-05-18）（校对编辑：姚丽娜）灶ADC值降低，具有一定MRI表现特点。(4)增强扫描60个病灶强化，6个病灶无强化，强化形态特点31个病灶不规则非闭合环状强化(半月征)，开口朝向皮质或基底节区灰质，4个病灶环状强化、15个病灶例垂直侧脑室火焰状强化并可见垂直于脑室的扩张静脉影，呈梳齿样结构，既梳齿征，具有一定MRI表现特点，10个病灶不规则斑片状强化，国内一项研究表明脑部炎性脱髓鞘假瘤强化随着临床进程有一定的变化特点，急性期(小于3周)呈斑片状、结节样强化，亚急性期(4-6周)呈开环、闭环样强化，慢性期(大于7周)还成开环、闭环样强化，但强化程度逐渐降低。6个病灶无强化。(5)氢质子磁共振波普(1H-MRS)主要反应组织代谢情况，扫描显示46例患者 NAA峰均有轻度降低