放射学实践
放射學實踐
방사학실천
RADIOLOGIC PRACTICE
2014年
8期
909-913
,共5页
可逆性后部脑病综合征%妊娠期高血压%血管源性脑水肿%体层摄影术,X 线计算机%磁共振成像
可逆性後部腦病綜閤徵%妊娠期高血壓%血管源性腦水腫%體層攝影術,X 線計算機%磁共振成像
가역성후부뇌병종합정%임신기고혈압%혈관원성뇌수종%체층섭영술,X 선계산궤%자공진성상
Reversible posterior encephalopathy syndrome%Hypertensive disorders in pregnancy%Cerebral edema,vasogenic%Tomography,X-ray computed%Magnetic resonance imaging
目的：探讨妊娠期高血压疾病合并可逆性后部脑病综合征（RPES）的影像学特征，提高对此病的认识。方法：回顾性分析35例妊娠期高血压合并 RPES 患者的临床及影像学特征。首次影像学检查：CT 检查19例，MRI 检查16例。影像学复查：17例患者于首次检查后3～14 d 进行复查，平均复查间隔时间为6 d，其中 CT 复查7例，MRI 复查10例。结果：RPES 主要表现为对称性皮层下脑水肿，于 CT 图像上呈不规则形低密度区，于 MR T2 WI 上呈高信号，主要位于双侧顶枕叶（32/35），其次是额叶（23/35）和颞叶（16/35），也累及深部脑白质（15/35）和基底节区（11/35），小脑（5/35）和脑干（3/35）偶有累及；合并蛛网膜下腔出血2例。MRI 增强扫描：5例患者病灶均未见强化；MRA：左侧大脑中动脉闭塞1例，正常3例；2例患者 MRV 检查均正常；DWI：病灶多呈等信号或低信号（10/12），ADC 图上呈高信号；DWI 示2例病灶中出现斑点状高信号，ADC 图提示此区域扩散受限。复查：17例患者治疗后 CT 或 MRI 复查显示病灶完全消失13例，病灶范围明显缩小4例。结论：妊娠期高血压疾病合并 RPES 的影像学表现有一定特征性，主要表现为皮层下脑白质血管源性水肿，以累及后循环供血区域为主，双侧较对称，治疗后病变范围迅速减小甚至消失。
目的：探討妊娠期高血壓疾病閤併可逆性後部腦病綜閤徵（RPES）的影像學特徵，提高對此病的認識。方法：迴顧性分析35例妊娠期高血壓閤併 RPES 患者的臨床及影像學特徵。首次影像學檢查：CT 檢查19例，MRI 檢查16例。影像學複查：17例患者于首次檢查後3～14 d 進行複查，平均複查間隔時間為6 d，其中 CT 複查7例，MRI 複查10例。結果：RPES 主要錶現為對稱性皮層下腦水腫，于 CT 圖像上呈不規則形低密度區，于 MR T2 WI 上呈高信號，主要位于雙側頂枕葉（32/35），其次是額葉（23/35）和顳葉（16/35），也纍及深部腦白質（15/35）和基底節區（11/35），小腦（5/35）和腦榦（3/35）偶有纍及；閤併蛛網膜下腔齣血2例。MRI 增彊掃描：5例患者病竈均未見彊化；MRA：左側大腦中動脈閉塞1例，正常3例；2例患者 MRV 檢查均正常；DWI：病竈多呈等信號或低信號（10/12），ADC 圖上呈高信號；DWI 示2例病竈中齣現斑點狀高信號，ADC 圖提示此區域擴散受限。複查：17例患者治療後 CT 或 MRI 複查顯示病竈完全消失13例，病竈範圍明顯縮小4例。結論：妊娠期高血壓疾病閤併 RPES 的影像學錶現有一定特徵性，主要錶現為皮層下腦白質血管源性水腫，以纍及後循環供血區域為主，雙側較對稱，治療後病變範圍迅速減小甚至消失。
목적：탐토임신기고혈압질병합병가역성후부뇌병종합정（RPES）적영상학특정，제고대차병적인식。방법：회고성분석35례임신기고혈압합병 RPES 환자적림상급영상학특정。수차영상학검사：CT 검사19례，MRI 검사16례。영상학복사：17례환자우수차검사후3～14 d 진행복사，평균복사간격시간위6 d，기중 CT 복사7례，MRI 복사10례。결과：RPES 주요표현위대칭성피층하뇌수종，우 CT 도상상정불규칙형저밀도구，우 MR T2 WI 상정고신호，주요위우쌍측정침협（32/35），기차시액협（23/35）화섭협（16/35），야루급심부뇌백질（15/35）화기저절구（11/35），소뇌（5/35）화뇌간（3/35）우유루급；합병주망막하강출혈2례。MRI 증강소묘：5례환자병조균미견강화；MRA：좌측대뇌중동맥폐새1례，정상3례；2례환자 MRV 검사균정상；DWI：병조다정등신호혹저신호（10/12），ADC 도상정고신호；DWI 시2례병조중출현반점상고신호，ADC 도제시차구역확산수한。복사：17례환자치료후 CT 혹 MRI 복사현시병조완전소실13례，병조범위명현축소4례。결론：임신기고혈압질병합병 RPES 적영상학표현유일정특정성，주요표현위피층하뇌백질혈관원성수종，이루급후순배공혈구역위주，쌍측교대칭，치료후병변범위신속감소심지소실。
Objective:To investigate the imaging characteristics of hypertensive disorders in pregnancy complicating with reversible posterior encephalopathy syndrome (RPES),in order to improve the understanding of the disease entity. Methods:The clinical and imaging materials of 35 pregnant patients with hypertensive disorders and complicated with RPES were analyzed retrospectively.The initial imaging examination included CT (19 patients)and MR scanning (16 patients). Follow up examination was performed 3~14d (m=6d)afterward,with CT (7 patients)and MRI (10 patients).Results:The typical imaging findings of RPES were symmetrical subcortical cerebral edema presented as irregular low density area on CT images and hyperintense on MR T2 W images.The location of lesions were parieto-occipital regions (32/35),followed by frontal lobe (23/35),temporal lobe (16/35),deep-seated white matter (15/35),basal ganglia (11/35 ),cerebellum (5/35)and brainstem (3/35).2 cases were complicated with subarachnoid hemorrhage.No enhancement could be assessed in the 5 patients with enhanced MRI.Of all 4 cases with MRA,3 cases were normal,yet one case had left middle cerebral ar-tery obliteration.10 of the 12 lesions presented isointensity or hypointensity on DWI and 2 lesions showed punctate hyperin-tensity on ADC images,stippled hyperintensity were found in the lesions of this 2 cases on DWI.Of all 17 cases underwent follow-up CT or MRI after treatment,complete disappearance of lesions could be seen in 13 cases and obvious reduction of lesions in 4 cases.Conclusion:Certain characteristic imaging findings could be assessed in pregnant patient with hypertensive disorder complicated with RPES,which presented as symmetrical subcortex edema located in white matters due to vascular disorder,mainly involved the region supplied by posterior circulation,rapidly decreased or vanished after treatment.
