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目的分析中枢神经系统血管炎(CNSV)的MRI表现与特征,探讨f MRI对该病的诊断价值。方法对病理或临床证实的15例CNSV病例的MRI特点进行回顾性分析。结果随机分布多发病灶13例,幕上单发病灶2例。T1WI等或稍低信号13例,混杂信号2例;T2WI稍高或者高信号12例,混杂信号3例;全部病灶T2-FLAIR为高信号。DWI高信号病灶9例(6例夹杂点状低信号),等信号病灶3例,低信号灶3例。10例SWI扫描患者中均见渗出性微出血低信号,其中病灶侧静脉扩张6例,对侧静脉扩张1例。灌注成像8例,其中7例为略低灌注,1例灌注增高。增强扫描以斑片状、脑回样强化为主,2例T2WI高信号病灶未见强化,血管壁增厚伴明显强化9例,5例脑膜动脉强化,4例病灶周围软脑膜强化。11例TOF-MRA血管成像中,5例血管呈串珠样改变,1例大脑中动脉闭塞呈“Moya-Moya”病改变,5例血管未见异常。2例DSA均见血管呈串珠样改变,其中包含1例TOF-MRA阴性病例。CNSV确诊前MRI复查,7例出现新发病灶,6例原发病灶有进展,2例变化不大。13例CNSV经过激素冲击等对症治疗后复查MRI,11例原有病灶明显缩小或者吸收,1例见新发病灶,1例变化不明显。结论 CNSV具有特征性MRI表现,MRI检查有利于早期诊断及指导活检取材。
Objective To analyze the MRI features and features of central nervous system vasculitis (CNSV) and to evaluate the diagnostic value of f MRI in this disease. Methods MRI features of 15 cases of pathologically or clinically confirmed CNSV were retrospectively analyzed. Results Randomly distributed in 13 cases of multiple lesions, supratentorial lesions in 2 cases. T1WI or slightly lower signal in 13 cases, mixed signal in 2 cases; T2WI slightly higher or high signal in 12 cases, mixed signal in 3 cases; all lesions T2-FLAIR high signal. DWI high signal lesions in 9 cases (6 cases of punctate low signal), 3 cases of equal signal lesions, 3 cases of low signal lesions. 10 cases of SWI scan patients were seen exudative micro-hemorrhage low signal, including lesions in 6 cases of lateral venous dilatation, contralateral venous dilatation in 1 case. Perfusion imaging in 8 cases, of which 7 cases of slightly lower perfusion, 1 case of perfusion increased. The enhancement scan was mainly patchy and retroccipital retrobulbar enhancement. No enhancement was observed in 2 T2WI high signal lesions, thickening of vessel wall accompanied by significant enhancement in 9, enhancement of 5 meningeal arteries, enhancement of pia mater in 4 lesions. In 11 cases of TOF-MRA angiography, 5 cases of blood vessels were beaded-like changes, 1 case of middle cerebral artery occlusion was “Moya-Moya ” disease changes, 5 cases of vascular abnormalities. Two cases of DSA showed beaded changes in blood vessels, including one case of TOF-MRA negative. Before the diagnosis of CNSV MRI review, new lesions occurred in 7 cases, 6 cases of primary lesions progress, 2 cases changed little. 13 cases of CNSV after hormone therapy and other symptomatic treatment after the review of MRI, 11 cases of original lesion was significantly reduced or absorbed, 1 case of new lesions, 1 case of change was not obvious. Conclusion CNSV has the characteristic MRI manifestations, MRI examination is conducive to early diagnosis and guidance of biopsy material.