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中枢神经系统脱髓 鞘性假瘤的MRI特征 与诊断价值研究

作者:孙长录

所属单位:河南省新乡市中心医院磁共振室 (河南 新乡 453000)

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摘要

目的 探讨中枢神经系统脱髓鞘 性假瘤磁共振成像(MRI)特征及诊断价 值。方法 对2010年6月-2017年6月收治的 15例中枢神经系统脱髓鞘性假瘤(均经临 床或病理证实)患者的MRI影像学资料进行 回顾性分析,总结其MRI平扫及增强扫描 图像特征。结果 MRI平扫特征:颅内病 变12例(其中单发7例,多发5例),C2-C5 层面颈髓病变3例;单发病变直径平均 (3.89±1.45)cm,颈髓病变均为条带状; 不规则形态10例,类圆形或卵圆形2例; 边界清晰9例,边界不清6例;病灶周边轻 微水肿12例。MRI信号及增强扫描特征: 长T1长T2信号12例,等T1长T2信号3例; 均不存在囊变及钙化;增强后环状强化4 例,半开环状强化2例(“开环征”、“垂 直征”)。结论 “开环征”等中枢神经系 统脱髓鞘性假瘤MRI增强扫描典型特征对 疾病诊断有一定的价值。

Objective To investigate the features and diagnostic value of magnetic resonance imaging (MRI) in demyelinating pseudotumor of central nervous system. Methods The imaging data of 15 patients with demyelinating pseudotumor of central nervous system (confirmed by clinic or pathology) who treated from June 2010 to June 2017 were analyzed retrospectively. Image features of MRI scan and enhanced scan were summarized. Results Findings of MRI scan showed intracranial lesions in 12 cases (including 7 cases of solitary lesions, 5 cases of multiple lesions) and cervical spinal cord lesions of C2-C5 level in 3 cases. The average diameter of solitary lesions was (3.89±1.45) cm, and cervical lesions were stripped. The lesions were irregular in 10 cases, quasi-circular or oval in 2 cases. The boundaries were clear in 9 cases and unclear in 6 cases. There was mild edema around lesions in 12 cases. MRI signal and features of enhanced scan showed long T1 and long T2 signals in 12 cases, equal T1 and long T2 signals in 3 cases. There was no cystic change or calcification. There was ring enhancement in 4 cases and semi-open ring enhancement in 2 cases (ring opening sign and vertical sign) after enhanced scanning. Conclusion The typical features of MRI enhanced scan like ring opening sign are of certain value in the diagnosis of demyelinating pseudotumor of central nervous system.

【关键词】中枢神经系统;脱髓鞘性假瘤 磁共振成像;影像学特征

【中图分类号】R445.2;R744.5

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.12.003

前言

中枢神经系统脱髓鞘性假瘤在临床上比较少见,其介于多发性硬 化与急性播散性脑脊髓炎间,也称之为假瘤性炎性脱髓鞘病,表现出 头痛、认知异常等症状[1-2]。脱髓鞘性假瘤影像学上与肿瘤占位病变 类似,易被误诊为胶质瘤,而两者治疗方案差异大,预后也完全不 同[3]。为此提高中枢神经系统脱髓鞘性假瘤检出率及疾病认识具有十 分重要的意义。磁共振成像(MRI)近年来在神经系统疾病诊断中应用 较多,技术成熟,利用增强扫描、多方位成像等多种形式可对病变范 围、邻近组织更好的反映[4]。本研究回顾性分析我院2010年6月~2017 年6月经临床或病理证实的15例中枢神经系统脱髓鞘性假瘤的MRI影像 学资料,总结MRI特点,以为临床疾病诊断、鉴别提供依据。