河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (2): 209-213.doi: 10.3969/j.issn.1007-3205.2021.02.019

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MRI对成人可逆性胼胝体压部病变综合征和脑梗死的鉴别诊断及预后评估

  

  1. 1.河北中石油中心医院医学影像科,河北 廊坊 065000;2.河北中石油中心医院风湿免疫科,河北 廊坊 065000
  • 出版日期:2021-02-25 发布日期:2021-03-09
  • 作者简介:赵永强（1985-）,男,河北固安人，河北中石油中心医院主治医师，医学学士，从事医学影像学研究。
  • 基金资助:
    廊坊市科学技术研究与发展计划（2020013140）

MRI in differential diagnosis and prognostic evaluation of reversible splenial lesion syndrome and ischemic cerebral infarction in adults

  1. 1.Department of Medical Imaging, Central Hospital of China National Petroleum Corporation, Hebei 
    Province, Langfang 065000, China; 2.Department of Rheumatology and Immunology, Central 
    Hospital of China National Petroleum Corporation, Hebei Province, Langfang 065000, China
  • Online:2021-02-25 Published:2021-03-09

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摘要： 目的  探究成人可逆性胼胝体压部病变综合征(reversible spleniallesion syndrome，RESLES)与脑梗死的MRI表现特征差异，并分析MRI对疾病预后的评估价值。
方法  选取21例RESLES患者和39例脑梗死患者作为研究对象，记录两组患者的MRI影像学中的病灶位置、形态和成像特点，分析两组患者的MRI影像学资料差异。
结果  21例RESLES患者病灶集中在胼胝体压部中线上，以中线位为中心分布对称，均为孤立、类圆形信号影像，包括10例圆形信号、8例椭圆形信号和3例梭形信号。MRI平扫表现为：T1加权成像（T1 weighted image，T1WI）呈稍低信号、T2加权成像（T2 weighted image，T2WI）呈稍高信号、磁共振成像液体衰减反转恢复序列（fluid attenuated inversion recovery，FLAIR）呈稍高信号、弥散加权像（diffusionweightedimaging，DWI）呈显著高信号；表观扩散系数（apparent diffusion coefficient，ADC）呈低信号，平均值为(0.407 2±0.099 5)×10-3 mm2/s；病灶平均最大横截面积为（95.86±7.05）mm2，MRI复查间隔时间为8~30 d。经过治疗后，所有患者影像学检查基本消除病灶。39例脑梗死患者中有37例合并有其他脑部病灶，36例胼胝体压部病灶为单发病灶，3例为胼胝体压部多发病灶，病灶多呈现片、条状或不规则形。影像学中DWI呈高信号，ADC平均值为(0.431 6±0.010 4)×10-3 mm2/s，病灶平均最大横截面积为（100.06±21.84）mm2。两组患者ADC值和病灶平均最大横截面积差异无统计学意义(P＞0.05)。
结论  RESLES患者与胼胝体梗死患者的MRI影像学特征显示，病灶与胼胝体压部中线的关系、病灶的形态都可作为区分两种疾病的有效手段，还可以脑内其他病灶的存在与否作为辅助鉴别依据。本研究中两组疾病患者的病灶ADC值差异无统计学意义，是否对疾病鉴别诊断提供价值还需作进一步分析。


关键词: 脑梗死, 胼胝体压部病变综合征, 磁共振成像

Abstract: Objective  To explore the difference in MRI manifestations between reversible splenial lesion syndrome(RESLES) and cerebral infarction in adults, and to analyze the prognostic value of MRI. 
Methods  We selected 21 patients with RESLES and 39 patients with infarction as the research subjects. The location, morphology and imaging characteristics of the lesions in the MRI imaging of the two groups were recorded, and the differences in MRI imaging data of the two groups were analyzed. 
Results  The lesions of 21 RESLES patients were concentrated on the midline of the corpus callosum, symmetrically distributed around the midline position, and all were isolated and circular-like signal images, including 10 cases of circular signals, 8 cases of elliptical signals and 3 cases of fusiform signal. MRI plain scan revealed slightly low signal on T1-weighted imaging(T1WI), slightly higher signal on T2-weighted imaging(T2WI), slightly higher signal on MRI fluid attenuated inversion recovery(FLAIR) sequence, significant high signal on diffusion weighted image(DWI); low signal intensity on apparent diffusion coefficient(ADC) map, with an average value of(0.407 2±0.099 5)×10-3 mm2/s; average maximum cross-sectional area of the lesion was(95.86±7.05) mm2. MRI reexamination interval was 8-30 d. After treatment, imaging examinations of all patients showed the lesions were practically eliminated. Among them, there were 37 patients with cerebral infarction combined with other brain lesions, 36 cases of splenial lesions were single lesions, 3 cases of splenial lesions with multiple lesions, and the lesions were mostly slices, strips or in irregular shapes. Imaging examination showed high signal on DWI, the average ADC was(0.431 6±0.010 4)×10-3 mm2/s, and the average maximum cross-sectional area of the lesion was(100.06±21.84) mm2. There was no statistical difference in ADC values between the two groups(P＞0.05). 
Conclusion  The MRI imaging features of patients with RESLES and corpus callosum infarction showed that the relationship between the lesion and the midline of the corpus callosum and the shape of the lesion could be used as an effective means to differentiate the two diseases, and that the presence or absence of other lesions in the brain could be used for auxiliary identification. In this study, there was no significant difference in the ADC value in patients of the two groups. Further analysis is needed to confirm whether it is valuable for differential diagnosis of the disease. 


Key words: brain infarctio； splenial lesion syndrome, magnetic resonance imaging

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