原发性中枢神经系统血管炎的MRI特征
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摘要
目的分析原发性中枢神经系统血管炎(PACNS)的MRI特征。方法回顾性分析16例PACNS患者的临床和MRI资料,观察其影像学表现特征。结果 16例PACNS,9例单发,7例多发,MRI共检出45个病灶,其中位于幕上38个(38/45,84.44%),脑干4个(4/45,8.89%),脊髓2个(2/45,4.44%),小脑半球1个(1/45,2.22%)。14例MRI表现为大片或斑片状影,2例表现为多发或单发肿块。病灶MR平扫呈T1WI低信号,T2WI高信号,FLAIR序列高信号;6例病灶内可见出血。16例DWI均呈高信号,其中ADC图呈高信号13例,低信号3例。病灶周围可见不同程度脑水肿。增强扫描14例可见强化,2例无明显强化。1例MRA检查可见左侧大脑前动脉A4段局限性狭窄。结论 PACNS的MRI表现复杂多样,需对病变影像学特征进行综合分析;肿块样PACNS与脑肿瘤鉴别困难。
Objective To explore MRI features of primary angiitis of central nervous system(PACNS).MethodsClinical and imaging data of 16 patients with PACNS were retrospectively analyzed.MRI features of PACNS were observed.Results Among 16 patients with PACNS,9patients were found with single lesion and 7with multiple lesions.A total of 45 lesions were detected with MRI in all 16 patients,including 38lesions(38/45,84.44%)on the supratentorial,4lesions(4/45,8.89%)in the brainstem,2lesions(2/45,4.44%)in the spinal cord and 1lesion(1/45,2.22%)in cerebellum.Lesions of 14 patients were demonstrated large or patchy shaped on MRI,while multiple masses or single mass like lesions were found in the other 2patients.For MR plain scan,the lesions were mainly hypointense on T1 WI,hyperintense on T2 WI and FLAIR images.Hemorrhage lesions were found in 6patients.For DWI,hyperintense lesions were found in all of 16 patients,including 13 with hyperintense and 3 with hypointense in ADC map.Various degrees of edema were shown around the lesions.For enhanced MRI,enhanced lesions were found in 14 patients,while lesions without obvious enhancement were found in the other 2patients.Only 1patient underwent MRA,with A4 segment of the left anterior cerebral artery stenosis.Conclusion MRI manifestations of PACNS are complex and diverse.Comprehensive analysis of MRI features is needed,but mass-like PACNS is still difficult to be distinguished from brain tumors.
Objective To explore MRI features of primary angiitis of central nervous system(PACNS).MethodsClinical and imaging data of 16 patients with PACNS were retrospectively analyzed.MRI features of PACNS were observed.Results Among 16 patients with PACNS,9patients were found with single lesion and 7with multiple lesions.A total of 45 lesions were detected with MRI in all 16 patients,including 38lesions(38/45,84.44%)on the supratentorial,4lesions(4/45,8.89%)in the brainstem,2lesions(2/45,4.44%)in the spinal cord and 1lesion(1/45,2.22%)in cerebellum.Lesions of 14 patients were demonstrated large or patchy shaped on MRI,while multiple masses or single mass like lesions were found in the other 2patients.For MR plain scan,the lesions were mainly hypointense on T1 WI,hyperintense on T2 WI and FLAIR images.Hemorrhage lesions were found in 6patients.For DWI,hyperintense lesions were found in all of 16 patients,including 13 with hyperintense and 3 with hypointense in ADC map.Various degrees of edema were shown around the lesions.For enhanced MRI,enhanced lesions were found in 14 patients,while lesions without obvious enhancement were found in the other 2patients.Only 1patient underwent MRA,with A4 segment of the left anterior cerebral artery stenosis.Conclusion MRI manifestations of PACNS are complex and diverse.Comprehensive analysis of MRI features is needed,but mass-like PACNS is still difficult to be distinguished from brain tumors.
引文
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[10]刘永红,王亚明,刘望舒,等.24例原发性中枢神经系统血管炎患者的MRI表现.中国神经免疫学和神经病学杂志,2017,24(6):406-410.
[11] Hajj-Ali RA,Singhal AB,Benseler S,et al.Primary angiitis of the CNS.Lancet Neurol,2011,10(6):561-572.
[12] Ohno K,Saito Y,Kurata H,et al.Vessel wall enhancement in the diagnosis and management of primary angiitis of the central nervous system in children.Brain Dev,2016,38(7):694-698.
[13] Abdel Razek AA,Alvarez H,Bagg S,et al.Imaging spectrum of CNS vasculitis.Radiographics,2014,34(4):873-894.
[14] Becker J,Horn PA,Kewani K,et al.Primanry central nervous system vasculitis and its mimicking diseases-clinical features,outcome,comorbidities and diagnostic results—A case control study.Clin Neurol Neurosurg,2017,156:48-54.
[15] Gan C,Maingard J,Giles L,et al.Primary angiitis of the central nervous system presenting as mass lesion.J Clin Neurosci,2015,22(9):1528-1531.
[16] Kim S,Kim DK.Psychosis in primary angiitis of the central nervous system involving bilateral thalami:A case report.Gen Hosp Psychiatry,2015,37(3):275.e1-e3.
[17] Killeen T,Jucker D,Went P,et al.Solitary tumour-liking mass lesions of central of the central nervous system:Primary angiitis of the CNS and infamnatory perudotumour. Clin Neurol Neurosurg,2015,135:34-37.
[2] Hajj-Ali RA,Calabrese LH.Primary angiitis of the central nervous system.Autoimmun Rev,2013,12(4):463-466.
[3] Hajj-Ali RA,Calabrese LH.Diagnosis and classification of central nervous system vasculitis.J Autoimmun,2014,48-49:149-152.
[4] Pagni F,Isimbaldi G,Vergani F,et al.Primary angiitis of the central nervous system:2 atypical case.Folia Neuropathol,2012,50(3):293-299.
[5] de Boysson H,Zuber M,Naggara O,et al.Primary angiitis of the central nervous system:Description of the first-two adults enrolled in the French Cohort of patients with primary vasculitis of the central nervous system.Arthritis Rheumatol,2014,66(5):1315-1326.
[6] Niu L, Wang L,Yin X,et al.Role of magnetic resonance imaging in the diagnosis of primary central nervous system angiitis.Exp Ther Med,2017,14(1):555-560.
[7] Aviv RI,Benseler SM,Silverman ED,et al.MR imaging and angiography of primary CNS vasculitis of childhood.AJNR Am J Neuroradiol,2006,27(1):192-199.
[8] Wilson N,Pohl D,Michaud J,et al.MRI and clinicopathological correlation of childhood primary central nervos system angiitis.Clin Radiol,2016,71(11):1160-1167.
[9] Katsetos CD,Poletto E,Kasmire KE,et al.Childhood primary angiitis of central nervous system with metachronous hemorrhagic infarcts:A postmortem study with clinicopathologic correlation.Semin Pediatr Neurol,2014,21(2):184-194.
[10]刘永红,王亚明,刘望舒,等.24例原发性中枢神经系统血管炎患者的MRI表现.中国神经免疫学和神经病学杂志,2017,24(6):406-410.
[11] Hajj-Ali RA,Singhal AB,Benseler S,et al.Primary angiitis of the CNS.Lancet Neurol,2011,10(6):561-572.
[12] Ohno K,Saito Y,Kurata H,et al.Vessel wall enhancement in the diagnosis and management of primary angiitis of the central nervous system in children.Brain Dev,2016,38(7):694-698.
[13] Abdel Razek AA,Alvarez H,Bagg S,et al.Imaging spectrum of CNS vasculitis.Radiographics,2014,34(4):873-894.
[14] Becker J,Horn PA,Kewani K,et al.Primanry central nervous system vasculitis and its mimicking diseases-clinical features,outcome,comorbidities and diagnostic results—A case control study.Clin Neurol Neurosurg,2017,156:48-54.
[15] Gan C,Maingard J,Giles L,et al.Primary angiitis of the central nervous system presenting as mass lesion.J Clin Neurosci,2015,22(9):1528-1531.
[16] Kim S,Kim DK.Psychosis in primary angiitis of the central nervous system involving bilateral thalami:A case report.Gen Hosp Psychiatry,2015,37(3):275.e1-e3.
[17] Killeen T,Jucker D,Went P,et al.Solitary tumour-liking mass lesions of central of the central nervous system:Primary angiitis of the CNS and infamnatory perudotumour. Clin Neurol Neurosurg,2015,135:34-37.