中毒性脑病的影像学表现及DWI的价值

　中枢神经影像学

Im aging features of toxic encephalopathy and the values of DWI

L I U Qi ng 2xi an ,X I A S huang ,QI J i

3

(De partment of Radiology ,the Fi rst Cent ral Hos pital ,Tianj in Medical Universit y ,Tianj in 300192,China )

[Abstract]　Objective To assess the CT and MR imaging of toxic encephalopathy 1Methods Eight patients suffered f rom different toxic substance were studied ,including 2cases with solvents ,3cases with hydrogen sulfide inhalation ,2cases with organophosphate poisoning and 1case with diazepam poisoning 1Three of them underwent cranial CT examination ,4under 2went cranial MR examination.One of them underwent both CT and MR examination 1R esults Toxic encephalopathy mainly involved the white matter and some nucleus ,and gray matter was also involved 1CT and MR imaging had some common ap 2pearances 1On CT ,symmetrical low densities were observed in the white matter and nucleus 1On MRI ,these lesions showed long T1and long T2signal intensity and on DWI showed hyperintensity 1The toxic encephalopathy MR imaging caused by chronic organic solvent inhalation revealed long T1and long T2white matter and nuclei changes ,on DWI showed hyperin 2tensity ,and the value of ADC increased ,which meant the edema was vesogenic edema 1Conclusion CT and MRI can detect the leukoencephalopathy ,the nuclei degeneration and necrosis of toxic encephalopathy 1DWI is more sensitive to detect the abnormalities of the white matter than routine MRI 1

[K ey w ords]　Neurotoxicity syndromes ;Tomography ,X 2ray computed ;Magnetic resonance imaging

中毒性脑病的影像学表现及DWI 的价值

刘庆先,夏　爽,祁　吉3

(天津医科大学一中心临床学院放射科,天津　300192)

[摘　要]　目的　观察各种中毒性脑病的CT 与MRI 表现。方法　8例中毒性脑病患者,其中3例接受CT 检查,4例接受MRI 检查,1例接受CT 和MR 检查。结果　中毒性脑病主要累及脑白质,部分神经核团及灰质也可受累,MRI 均见广泛

脑白质长T1、长T2信号,弥散加权成像(DWI )呈高信号,CT 表现为相应部位低密度,病变对称分布,无占位效应。有机溶剂中毒性脑病表现为广泛的大脑白质及神经核团长T1、长T2信号,DWI 呈高信号,提示血管源性水肿;H 2S 中毒性脑病表现为大脑白质及部分神经核团多发长T1、长T2信号,DWI 呈高信号,ADC 值降低,40天后复查MRI 病变范围较前缩小,

DWI 信号较前减低;有机磷及安定中毒性脑病均表现为弥漫性脑水肿,灰白质均受累。结论　CT 和MRI 能发现脑白质及

神经核团的变性和坏死改变。与常规MRI 相比,DWI 能更敏感地反映病变。

[关键词]　神经毒性综合征;体层摄影术,X 线计算机;磁共振成像

[中图分类号]　R74916;R44512　[文献标识码]　A [文章编号]　100323289(2009)0120054204

[作者简介]刘庆先(1980-),女,河北保定人,在读硕士,医师。研究方

向:神经系统影像诊断。E 2mail :shij8000@1631com

[通讯作者]祁吉,天津市第一中心医院放射科,300192。E 2mail :cjr 1qiji @vip 11631com

[收稿日期]2008207215 [修回日期]2008210209

中毒性脑病主要引起脑白质病变,也可引起部分神经核

团及灰质的改变。CT 和MRI 有助于对中毒引起的脑实质改变做出早期诊断。本文回顾性分析8例不同原因中毒性脑病患者的影像学资料,观察CT 和MRI 表现,并评价DWI 对本病的价值。1　资料与方法111临床资料　患者8例,其中男5例,女3例,年龄18～54

岁,平均4113岁,均有明确中毒史。其中有机溶剂中毒患者

2例,均为女性,年龄分别为21岁、22岁;硫化氢(H 2S )中毒患者3例,均为男性,年龄51～54岁;有机磷中毒患者2例,男1例,18岁,女1例,51岁;安定中毒患者1例,男,46岁。112检查方法　CT 检查采用GE High Speed 16层螺旋CT 机,扫描参数为:层厚5～10mm ,120kV ,120～160mAs ;MR 检查采用Marconi Eclip se 115T 磁共振扫描仪,头线圈,检查序列包括:T1WI (TR 400ms ,TE 10ms ),T2WI (TR 5400,TE 120ms ),FL A IR (TR 6500ms ,TE 120ms ),SE 2EPI (TR 6000ms ,TE 9517ms ,FL IP 90°,b =1000s/mm 2),横断面、冠状面及矢状面成像,层厚515mm ,间隔1mm ,FOV 25cm ×25cm ,矩阵256×192。2　结果