CAJ | 학술논문

目的分析瘤样炎性脱髓鞘病(TIDD)的磁共振成像/氢质子磁共振波谱(MRI/1HMRS)特征,探讨MRI/1H-MRS对TIDD的临床应用价值.方法回顾性分析10例经病理证实的脑TIDD的MRI征象,并与病理进行对照.结果病变主要位于脑白质,占位效应较轻.MRI平扫均呈T1低T2高信号,DWI 7例呈明显高信号,3例呈稍高或高低混杂信号.MRI增强:5例明显强化呈“开环征”,4例斑片状或结节样明显强化,l例片状或线状轻度强化.3例内缘显示扩张血管影,垂直于侧脑室壁.4例1H-MRS均表现为乳酸和脂质明显升高;3例出现谷氨酸和谷氨酰胺的复合物β,γ-谷氨酸复合物峰升高,N-乙酰天冬氨酸均不同程度降低,胆碱升高.病理表现为病变区髓鞘脱失,炎细胞浸润伴反应性星形胶质细胞增生、肥大及异常核分裂象,7例见具有核分裂的肥胖型胶质细胞.结论 TIDD的MRI征象有其突出特点:水肿明显占位效应轻,MRI增强可见“开环征”及扩张小静脉,肿块呈低灌注,1 H-MRS出现明显升高β,γ-谷氨酸复合物峰,乳酸和脂质峰明显升高,N-乙酰天冬氨酸轻度减低,胆碱轻度升高,综合分析MRI及1H-MRS典型特征,结合临床表现,有助诊断.
목적 분석류양염성탈수초병(TIDD)적자공진성상/경질자자공진파보(MRI/1HMRS)특정,탐토MRI/1H-MRS대TIDD적림상응용개치.방법 회고성분석10례경병리증실적뇌TIDD적MRI정상,병여병리진행대조.결과 병변주요위우뇌백질,점위효응교경.MRI평소균정T1저T2고신호,DWI 7례정명현고신호,3례정초고혹고저혼잡신호.MRI증강:5례명현강화정“개배정”,4례반편상혹결절양명현강화,l례편상혹선상경도강화.3례내연현시확장혈관영,수직우측뇌실벽.4례1H-MRS균표현위유산화지질명현승고;3례출현곡안산화곡안선알적복합물β,γ-곡안산복합물봉승고,N-을선천동안산균불동정도강저,담감승고.병리표현위병변구수초탈실,염세포침윤반반응성성형효질세포증생、비대급이상핵분렬상,7례견구유핵분렬적비반형효질세포.결론 TIDD적MRI정상유기돌출특점:수종명현점위효응경,MRI증강가견“개배정”급확장소정맥,종괴정저관주,1 H-MRS출현명현승고β,γ-곡안산복합물봉,유산화지질봉명현승고,N-을선천동안산경도감저,담감경도승고,종합분석MRI급1H-MRS전형특정,결합림상표현,유조진단.
Objective To summarize the magnetic resonance imaging/ 1 H-magnetic resonance spectroscopy (MRI/1 H-MRS) features of tumor-like inflammatory demyelinating diseases (TIDD),and investigate the clinical value of MRI/1 H-MRS.Methods MRI features of 10 cases of TIDD in brain confirmed by pathology were retrospectively analyzed and compared with pathology.Results The lesions mainly located in the white matter with mild mass effect.MRI scan all showed low T1 high T2 signal,and 7 cases showed high signal,3 cases showed slightly high or mixed signals on DWI.Enhanced MRI showed 5 cases with significant enhancement with " open loop" sign,4 cases with significant patchy or nodular enhancement,1 case with mild flakes or linear enhancement.Three cases showed expanded blood vessels and plumbed to the lateral wall inside the edge of the lesions.1H-MRS performance showed 4 cases all with significantly increased Lac and Lip; 3 cases with rised glutamate and glutamine complex β,γ-Glx peaks,reduced N-acetylaspartate acid (NAA),increased Cho to varying degrees.All pathological changes were demyelination,perivascular inflammatory infiltration and reactive gliosis,hypertrophy and abnormal mitotic figure.Seven cases could be seen obesity glial cells.Conclusions TIDD had its salient MRI features:lesion had obvious edema and mild mass effect,MRI enhancement showed "open loop" sign and small veins expansed,on perfusion-weighted imaging it showed low perfusion.1H-MRS showed β,γ-Glx peaks,Lac and Lip peaks significantly increased,NAA slightly reduced,Cho mildly elevated.Comprehensively analyzing the MRI and 1H-MRS features,combined with clinical manifestations,contribute to the diagnosis of the disease.