炎性脱髓鞘性假瘤精选.docVIP

脑炎性脱髓鞘性假瘤MRI及MRS表现马军洁郭广卿王厚革濮阳市中医院放射科邮编：45700【摘要】 目的分析炎性脱髓鞘性假瘤的MRI 及MRS表现, 探讨此病变的MRI、MRS 诊断价值。 方法对10例经手术病理证实及2 例经临床证实的脑炎性脱髓鞘性假瘤进行了MRI平扫及增强扫描, 对其MRI及MRS影像学表现进行了回顾性分析。 结果MRI平扫显示9 例病变均表现为局灶性占位,3例为多灶性病变；7例呈均匀长T2长T1 信号, 5 例呈混杂T2、T1信号; 12例均经钆喷替酸葡甲胺(Gd-DTPA)静脉注射，增强扫描示病灶均有明显不均一强化，可呈开环状或闭环状强化。 结论：脑炎性脱髓鞘性假瘤的MRI及MRS表现有一定影像特征且临床表现不支持占位性病变时，应考虑此病的可能性大，必要时可先行激素冲击治疗, 以避免手术或放射治疗造成的严重损伤。 MRI and MRS findings of Tumefactive demyelinating lesions of brain Ma Jun-jie ，Guoguang-qing and Wang Houge （Radiology Department,Chinese Medicine Hospital，Pu Yang,Henan457001） [Abstract] Purpose to analyse MRI and MRS findings of Tumefactive demyelinating lesions of brain.Materials and methods：10 pathological proven and 2 clinical proven patients of TDLs were retrospectively analysedResults: all the 12 cases showed local masses and 3cases of them were multifocal lesions.7 cases showed long T2 and long T1 signal intensity and 5 cases showed mixed T2 and T1 signal intensity.The leisions presented variable enhancement patterns(open—ring sign or close-ring sign etc.) after Gd-DTPA administration.Conclusion: There are some characteristics in cerebral tumefactive demyelinating lesions of brain.This kind of diseases should be considered when atypical tumor-like leision is found.Experimental steroid stoss therapy and follwed-up are helpful for differential diagnosis in necessary to avoid severe injury because of operation or radio therapy. Key words：Tumefactive demyelinating lesions ,MRI, MRS. 【关键词】 炎性脱髓鞘性假瘤; 磁共振成像; MRS中枢神经系统以神经髓鞘脱失为主，神经元胞体及其轴索相对受累较轻为特征的一组疾病，(如多发性硬化和急性播散性脑脊髓炎。而表现为占位的炎性脱髓鞘假瘤则很少见, 炎性脱髓鞘假瘤又称局灶肿瘤样脱髓鞘病变或炎性髓鞘破坏性弥漫性硬化等，即局灶性、孤立、边界不清的占位性病变，无论是临床、还是影像表现甚至病理学都类似肿瘤的病变。笔者搜集本院7年来12例炎性脱髓鞘性假瘤的病例，对该病MRI表现女5例，年龄8-55岁，平均31.5岁。临床为急性或亚急性发病者8例（病程为2周-2月），呈慢性经过者4例流体抑制翻转恢复（T2FLAIR）序列扫描，参数数值如下：T1WI TR400-500ms，TE1-19ms，T2WI TR2000-3500ms，TE -100ms，常规采用矢状位和横轴位扫描，必要时加扫冠状位，扫描层厚5-8.5mm，2. MRI及MRS表现： （1）病变部位：大脑半球5例（双侧额叶3例，左额7例呈均匀长T1信号，5例呈（8）MRS：NAA/Cr的下降幅度均较小，8例见谷氨酸盐和谷氨酰胺峰。 ①为T2WI②为T1WI③、④为T2FLAIR，⑤、⑥为DWI，⑦、⑧为ADC图，⑨、⑩为横断