作者单位:100053北京,首都医科大学宣武医院放射科(高勇安、张念察、李坤成、张轶群);神经内科(张通)�中枢神经放射学�胼胝体变性的CT和MRI分析高勇安张念察李坤成张轶群张通摘要目的:分析胼胝体变性的CT和MRI征象。材料与方法:4例胼胝体变性中,3例为急性发病,1例呈慢性过程。4例均行头颅CT扫描,2例行MRI检查,其中1例同时行MRI增强扫描。结果:2例CT示胼胝体膝部和压部呈片状低密度病变,2例病变仅见于膝部。病变的膝部(3例)和压部(2例)呈膨胀性改变,其中1例发病16天后,MRI平扫和强化未见膨胀性改变和异常强化。结论:(1)CT和MRI是诊断胼胝体变性的有效方法,MRI显示胼胝体更全面准确,特别是体部的显示;(2)胼胝体变性CT主要表现是片状低密度灶,急性发病者以膝部和压部常见,可见膨胀性改变,以膝部尤著;(3)晚期胼胝体病变区萎缩,MRI表现为胼胝体中层带状低信号(T1WI),无强化。关键词胼胝体变性CTMRIMarchiafava-BignamiDisease:AnalysisofCTandMRIFindingsGaoYongan,ZhangNiancha,LiKuncheng,etal.DepartmentofRadiology,XuanwuHospital,CapitalUniversityofMedicalSciences,Beijing100053,P.R.ChinaABSTRACTObjective:ToanalyzetheCTandMRIfindingsofMarchiafava2Bignamidisease.MaterialsandMethods:Theclinicalfeaturesof4cases(3acuteformand1chronicform)werecorrelatedwiththefindingsonCT(n=4)andMRI(n=2).Results:CTrevealedalargelow2densityareaingenuandsplenium(n=2)oringenuonly(n=2).Expansionoftheaffectedgenu(n=3)andsplenium(n=2)wasobservedintheearlystage.Theenlargementandabnormalenhancementofgenuinonepatientcouldnotdemonstratedonbothplainandcontrast2enhancedMRIperformed16daysafteronset.Conclusion:(1)BothCTandMRIareeffec2tivemodalitiesfordiagnosingMarchiafava2Bignamidisease.MRIshowsthecorpuscallosum,especiallyitsbody,moreclearly.(2)ThemainfeatureofMarchiafava2BignamidiseaseonCTisalow2densityarea.Inacuteform,enlargementofthesplenium,andparticularlyofthegenu,iscommonlyseen.(3)Inthelatestage,thelesionbecomesatrophied,andabnormalband2shapedlowsignalzonewithoutenhancementisseeninthemiddlelayerofcorpuscallosumonT1WI.KeywordsMarchiafava2BignamidiseaseCTMRICorpuscallosumdemyelination胼胝体变性(corpuscallosumdemyelination),又称Marchiafava2Bignamidisease,较少见。国内外文献仅见少数个案报道[1～6]。本文总结4例经我院诊治的胼胝体变性病例(1例曾作报道)[7],着重分析其CT和MRI表现,旨在提高对这类病变的认识和诊断水平。1材料与方法4例均为男性,年龄37～57岁。3例呈急性发病过程,表现为发作性四肢抽搐,2例伴有意识障碍。1例呈慢性发病过程,表现为渐进性双下肢无力,言语不清,记忆力下降等。患者均消瘦,营养不良,四肢肌张力偏高,腱反射活跃。4例既往都有20～30年嗜酒史,每日0.5kg左右白酒。实验室检查无显著异常。4例均行头颅CT扫描,2例同时行MRI检查,其中1例作MR增强扫描。应用SiemensHiQ全身CT扫描机,常规头颅CT扫描,层厚10mm,间隔10mm,病变区加扫5mm薄层。应用SiemensMagnetomImpact1.0T全身磁共振成像仪,采用常规SE序列行头颅MRI检查,T1WI:TR450ms,TE15ms;T2WI:TR4000ms,TE90ms,层厚6mm,间隔1.5mm。2结果2例CT显示胼胝体膝部和压部片状低密度;膝部低密度不均匀,以两侧病变较重,病灶边缘模糊,病变的膝部和压部呈膨胀性改变,以膝部为著,使双侧脑室前角变窄,压部低密度病灶较均一(图1、2)。2例CT仅见胼胝体膝部低密度灶,病变密度较均匀,压部未见异常:其中1例CT扫描膝部表现有膨胀性改变,2周后行MR扫描显示病变位于胼胝体膝2体区,T1WI为低信号,呈带状在胼胝体的中层,以两侧为著,冠状和矢状位清楚,轴位病变显示不清(T1WI和T2WI),病变区胼胝体脑室面不光整,呈萎缩性改变,增强后未见有强化征象(图3～5);另1例CT膝部未见膨胀性改变,MRI显示病变区胼胝体中层T1WI上带状低信号,胼胝体萎缩变形,胼胝体周围池扩大。4例中,3例表现有轻度脑萎缩。·354·临床放射学杂志1999年第18卷第8期3典型病例患者男,57岁。出现双下肢...
