急性播散性脑脊髓炎MRI表现窦国胜薛文俊平顶山市第一人民医院平顶山市467000摘要目的描述急性播散性脑脊髓炎的脑部MRI表现及临床特点。探讨MRI对本病的诊断价值。方法符合临床诊断标准的急性播散性脑脊髓炎患者21例,18例发病前有病毒感染或疫苗接种史。全部病例行头部MRI检查,18例行MRI复查。结果病变多发,不对称,大脑白质受累21例,16例同时累及丘脑,13例可见“垂直征”,19例异常增强,15例复查见异常信号缩小且数目减少。结论急性播散性脑脊髓炎均有脑部MRI改变且颇具特征性。结合病史及单相病程可作出早期诊断,MRI随诊是评价疗效的重要手段,MRI显示丘脑受累可作为鉴别本病与多发性硬化的主要依据。关键词脑脊髓炎急性播散性磁共振成像脑疾病中图分类号:R814142文献标识码:B文章编号:167223422(2006)0620015203ClinicalandBrainMRIStudyofAcuteDisseminatedEncephalomyelitisDOUGuosheng,XUEWenjunTheFirstPeople’sHospitalofPingdingshanCity,Pingdingshan467000,ChinaABSTRACTObjectiveTodescribetheMRIfindingsofthebraininacutedisseminateden2cephalomyelitis(ADEM)anditsclinicalfeaturesandtoevaluatetheusefulnessofMRIimagingindi2agnosingADEMandassessingthetherapy.Methods21casesofclinicallyprovenADEMwereretro2spectivelyreviewed.18patientshadahistoryofviralinfectionorvaccinationpriortotheonsetofADEM.MRIscanningofthebrainwasperformedinallcasesinacutestageandfollow-upMRIima2gingwasachievedin18cases.ResultsMultipleandasymmetricallesionswererevealedinthewhitematter(21cases),thalami(16cases).Thepatternofperpendiculardistributionagainstthelateralventricleswasdetectedin13cases.Contrastenhancementwasobservedin19cases.Follow-upMRIimagingshowedthattheabnormalsignalsdecreasedinbothsizeandnumberin15cases.ConclusionAbnormalsignalsareinallthepatientswithADEMandtheyhavesomecharacteristicsbywhichear2lydiagnosiscouldbemadeifcombinedwiththehistoryandmonophasicclinicalsetting.Follow-upMRIimagingplaysanimportantroleinfurtherconfirmingthediagnosisandinevaluatingthetherapyaswell.ThalamicinvolvementasshownbyMRIimagingprovedusefulindistinguishingbetweenADEMandmultiplesclerosis.KEYWORDSEncephalomyelitis;Acutedisseminated;Magneticresonanceimaging:Braindiseases急性播散性脑脊髓炎(acutedisseminateden2cephalomyelitis,ADEM),是一种较少见的中枢神经系统脱髓鞘疾病,多数在发病前1～2周有病毒感染或疫苗接种史,临床表现多样且无特征性。笔者收集了符合ADEM诊断标准的患者21例,对其临床表现及脑部MRI表现作一回顾性分析。1资料与方法111病例选择符合ADEM诊断标准患者21例,男18例,女3例,年龄5～46岁,平均21岁。112临床表现4例发病前1周患腮腺炎,3例2周前感染单纯疱疹病毒,3例注射狂犬疫苗2d后发病,4例注射流感疫苗2周后发病,1例注射白百·51·JournalofMedicalForumVol.27No.6March2006破5d后发病,4例发病前5d被毒虫咬伤,2例无明显诱因。均为急性起病。主要症状体征包括发热21例,意识模糊18例,肢体无力17例,语言不清10例,头疼6例,脑膜刺激征13例,精神异常5例,眼震6例,视乳头水肿8例,上升性麻痹7例,大小便失禁8例。CSF-MNC增高13例,CSF-IgG增高7例,寡克隆带阳性3例。EEG广泛中度异常16例。113MRI检查和治疗全部病例均作MRI常规扫描及增强扫描;18例治疗2周～1年后复查。治疗应用血浆置换、静脉注射丙种球蛋白(IVIG)及糖皮质激素治疗。2结果首次MRI所见病变累及半卵圆中央及侧室旁白质21例(双侧16例,单侧5例),16例同时累及丘脑,并累及胼胝体2例,中脑,延髓,小脑白质各3例。病变特点为多发不对称分布点,片状,其中13例大脑白质见“垂直征”。T1WI均为低信号,T2WI为高信号,合并出血见T2短信号,病变中心更长T1更长T2信号,为液化。注射Gd-DTPA后,19例环状或点片状增强,2例无强化。无脑萎缩。其中3例有双侧脑室扩大,脑沟、脑池及脑裂变窄。复查见15例异常信号缩小且数目减少。经治疗18周明显好转,2例死亡,随诊2年...
