CAJ | 학술논문

目的：分析甲氨蝶呤（ MTX）所致儿童急性脑病MRI及临床表现的特点。方法回顾性分析13例经临床确诊的MTX急性脑病的临床和影像资料。总结MRI表现特点，包括病灶位置、信号特征及MRI随访变化。结果13例患儿中，全身抽搐2例。言语不利5例，其中合并单侧偏瘫4例，合并右侧面瘫1例。单侧肢体无力5例。左侧偏瘫1例。10例病灶位于半卵圆中心和（或）脑室旁白质，表现为非对称性边界清楚DWI高信号， ADC图低信号。1例为双额、顶、枕皮层及皮层下片状长T2信号，DWI少许高信号。 MRI复查10例DWI异常信号全部吸收，8例于原DWI异常信号部位出现FLAIR高信号，5例范围较前减小，1例范围增大，2例范围无明显变化。1例额、顶、枕皮层及皮层下长T2信号范围减小，DWI异常信号消失。结论甲氨蝶呤所致急性脑病以卒中样发作为典型临床表现。 DWI是诊断本病最敏感的影像学检查方法，深部白质非对称性DWI异常信号为特征性改变。 MTX所致细胞毒性水肿为短暂且可逆过程。
목적：분석갑안접령（ MTX）소치인동급성뇌병MRI급림상표현적특점。방법회고성분석13례경림상학진적MTX급성뇌병적림상화영상자료。총결MRI표현특점，포괄병조위치、신호특정급MRI수방변화。결과13례환인중，전신추휵2례。언어불리5례，기중합병단측편탄4례，합병우측면탄1례。단측지체무력5례。좌측편탄1례。10례병조위우반란원중심화（혹）뇌실방백질，표현위비대칭성변계청초DWI고신호， ADC도저신호。1례위쌍액、정、침피층급피층하편상장T2신호，DWI소허고신호。 MRI복사10례DWI이상신호전부흡수，8례우원DWI이상신호부위출현FLAIR고신호，5례범위교전감소，1례범위증대，2례범위무명현변화。1례액、정、침피층급피층하장T2신호범위감소，DWI이상신호소실。결론갑안접령소치급성뇌병이졸중양발작위전형림상표현。 DWI시진단본병최민감적영상학검사방법，심부백질비대칭성DWI이상신호위특정성개변。 MTX소치세포독성수종위단잠차가역과정。
Objective To evaluate the MRI findings and clinical features of methotrexate-induced acute encephalopathy in children.Methods The clinical data and brain MRI obtained in 13 children with methotrexate-induced acute encephalopathy were retrospectively reviewed.The MRI features were analyzed , including information on the location , the signal intensity and follow-up MRI study was performed.Results Of the 13 patients , 2 patients suffered from seizure.Five patients had dysphasia , of which 4 patients had evidence of hemiparesis , 1 patient had right facial palsy.Five patients had unilateral weakness.And left hemiparesis was observed in 1 patient.DWI revealed well demarcated asymmetrical hyperintensity lesions within the centrum semiovale and/or periventricular white matter in 10 patients, corresponding to areas of hypointensity on ADC maps.One case showed hyperintensity areas in the bilateral supratentorial cortex and subcortical white matter on T 2-weighted images with subtle high-intensity on DWI.In all 10 cases there were resolution of the diffusion abnormality , 8 cases displayed residual FLAIR signal abnormalities involving areas of previously seen diffusion restriction , 5 cases showed decreased range of the lesion , 1 case was progressive, and 2 cases were stable.One case with hyperintensity areas in the supratentorial cortex and subcortical white matter showed small residual hyperintensity on T 2-weighted images and resolution of the diffusion abnormality.Conclusions MTX-induced acute encephalopathy often manifests as stoke-like symptoms.DWI is the imaging modality of choice for the detection of acute MTX neurotoxicity , and asymmetrical restricted diffusion in the deep white matter is the characteristic sign.Cytotoxic edema induced by MTX is transient and reversible .