摘要
目的探讨肝移植术后并发脑桥中央髓鞘溶解症（CPM）和脑桥外髓鞘溶解症（EPM）的MRI表现及MR扩散加权成像（DWI）的诊断价值。方法搜集并分析肝移植术后5例CPM和3例CPM伴EPM患者的临床和影像资料。8例患者原发病3例为乙肝肝硬化，1例为乙肝肝硬化、肝癌，1例为丙肝合并血吸虫性肝硬化，2例为丙肝肝硬化，1例为胆汁性肝硬化，男女各4例。所有患者检查均于Philips 1．5T MR机上进行。MR序列包括：T1WI，T2WI，横断面SE-回波平面成像（SE—EPI）DWI序列。结果MRI显示脑桥中央呈蝴蝶形、圆形、四边形长T1长T2信号影，周围脑桥组织和皮质脊髓束信号正常。病变于DWI上呈高信号，表观弥散系数（ADC）图上呈等或稍低信号，提示病变内水分子扩散受限。2例患者2个月复查MRI显示病变范围较前缩小，DWI呈等信号，ADC呈高信号，提示病变内水分子扩散增加；3例患者除脑桥中央病灶外，尾状核、苍白球、丘脑、外侧膝状体及大脑皮层于DWI及T2WI上亦可见高信号。结论MR扩散成像能够早期并敏感地显示脑桥中央及脑桥外髓鞘溶解症病变。
Objective To study the imaging of central pontine myelinolysis （CPM） and extrapontine myelinolysis （EPM） after liver transplantation and value of DWI. Methods Eight patients after liver transplantation with CPM and EPM were included in our study, 4 cases of female and 4 cases of male. MR examinations were performed on Philips 1.5 T MRI system. The sequences included SE T, WI, FSE T2WI,axial SE-EPI DWI,TR/TE 6225/118.7 ms, ETL 128, FLIP 90°, thickness 5 ram, matrix 128 × 128,b = 1000 mm^2/s. Results Four of B type hepatitis and cirrhosis and 1 case combined with hepatic carcinoma, 1 of C type hepatitis with cirrhosis from schistosome,2 of C type hepatitis and cirrhosis, 1 of cholangiogenic cirrhosis. MR demonstrated prolongation of T1 and T2 with a shape of butterfly, round or quadrangle on the brain stem sparing of the corticospinal tract and peripontine tissue. The lesion manifested high signal intensity both on DWI and ADC map indicating T2 effect and vasogenic edema Follow up MR in 2 cases 2 months later showed more prolongation of T1 and T2 than the first time and the lesion manifested iso-intensity signal on DWI and high signal intensity on ADC map suggesting increased diffusivity. Abnormal signal intensities were detected on the bilateral caudate head, globus pallidus, putamcn and cerebral cortex in 3 cases. Conclusion CPM should be considered when prolongation of T1 and T2 with a shape of butterfly, round or quadrangle on the brain stem, sparing of the corticospinal tract and peripontine tissue was detected for patients of post-transplantation. When combined with other area abnormality, EPM and CPM should be considered. DWI can early and sensitively show the lesion.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2008年第11期1160-1164,共5页
Chinese Journal of Radiology
关键词
肝移植术
髓鞘溶解症
MR特征
临床分析
Myelinolysis, central pontine
Diffusion magnetic resonance imaging
