脑桥中央髓鞘溶解症的MR影像诊断.doc

中华放射学杂志CHINESE JOURNAL OF RADIOLOGY1999年 第1期 No.1 1999 脑桥中央髓鞘溶解症的MR影像诊断（附三例分析）高培毅　林燕 　　【摘要】　目的　研究脑桥中央髓鞘溶解症（central pontine myelinolysis, CPM）的MRI特征。方法 回顾性分析3例CPM患者的MRI表现，总结MRI诊断与鉴别诊断要点。结果　CPM的MRI特征表现为：（1）病变位于脑桥中央部位，主要累及桥横纤维的髓鞘，皮质脊髓束的轴索保持完好；（2）病灶多表现为环形或蝴蝶样，边缘模糊；（3）T1WI病灶呈低信号强度影，T2WI则为高信号影；（4）病变的早期阶段可见病灶内有斑点样高信号强度影；（5）静脉注入造影剂Gd-DTPA后，可见病灶边缘轻度增强。结论　MRI是CPM的最好检查方法，当有上述表现时高度提示CPM的可能。　　【关键词】　脑桥　　髓鞘破坏，中心性脑桥　　磁共振成像MR imaging of central pontine myelinolysis（analysis of 3 cases）　　GAO Peiyi, LIN Yan. Department of Neuroradiology, Beijing Neurosurgery Institute, Beijing 100050　　【Abstract】　Objective　To delineate the MR imaging features of central pontine myelinolysis（CPM）. Methods　Three cases of CPM with history of chronic alcoholism and their MR imaging features were reviewed, the differential diagnosis was discussed. Results　MR appearances of CPM were as followed :（1 ）The location of CPM was in the center of the pons. Transverse pontine fibers were most severely affected with sparing of descending corticospinal tracts. （2）The lesion was ring-like or butterfly-like in shape with unclear margin. （3）Lesion appeared hypointense on T1 weighted image and hyperintense on T2 weighted image. （4）Scattered patchy high signal on T1 weighted image was seen in early stage. （5）Slight marginal enhancement with Gd-DTPA was revealed. Conclusions　CPM is best delineated by MR imaging. The MR imaging appearances are strongly suggestive of the diagnosis.　　【Key words】　Pons　　Myelinolysis, central pontine　　Magnetic resonance imaging　　脑桥中央髓鞘溶解症（central pontine myelin- olysis, CPM)是一少见而又致命的、以脑桥髓鞘溶解为特征的病变。CPM的临床表现与脑桥梗死相似，临床上很难将两者区分开。MR的问世为CPM的检出提供了一种有效的手段。笔者报告3例CPM的MR影像资料，并结合文献就其病理特点、MR影像诊断及鉴别诊断做一初步讨论，以供同道参考。 材料与方法 　　CPM患者3例，均为男性，年龄分别为37、42和45岁。3例患者均表现为急性起病，临床表现相似，主要为昏睡或昏迷、四肢瘫及假性球麻痹。3例患者发病前均有酗酒史，其中2例患者的工作为陪酒员，1例因家中盖房连续9天酗酒。　　MR机分别为0.3 T永磁型扫描机和1.5 T超导型扫描机。3例患者均作了矢状面和横断面扫描，T1WI TE为16～28毫秒，TR为500～600毫秒；T2WI TE为56～102毫秒，TR为1 500～3 000毫秒。扫描矩阵为256×256，采用头部专用线圈，2次平均成像。3例中2例在平扫后作了增强扫描。1例分别在发病后