Posterior Reversible Encephalopathy Syndrome: Magnetic Resonance Imaging and Diffusion-weighted Imaging in 12 Cases

後側腦部可逆性腦病變徵候群：12位病患之磁振造影及擴散加權影像分析

周美君(Mei-Chun Chou) ； 賴炳宏(Ping-Hong Lai) ； 葉力仁(Lee-Ren Yeh) ； 李介元(Jieh-Yuan Li) ； 苑梅剛(Mei-Kang Yuan) ； 梁慧隆(Huei-Lung Liang) ； 陳坤煌(Clement Chen) ； 潘慧本(Huay-Ben Pan) ； 盧玉強(Yuk-Keung Lo) ； 楊建芳(Chien Fang Yang)

《The Kaohsiung Journal of Medical Sciences》 20卷8期 (2004/08) Pp. 381-388

摘要

為了研究有關後側可逆性腦病變徵候群，我們回顧12位有關這類症候群的病患，研究其臨床資料及放射學影像，包括傳統磁振造影檢查、擴散加權影像檢查及擴散係數之腦部圖譜，並進而研究擴散加權影像對於後側可逆性腦病變徵候群之診斷所扮演之角色。12位病患（男性 3 位；女性 9 位），年齡介於11至70歲（平均年齡為 37 歲），經臨床資料及磁振造影影像診斷為後側可逆性腦病變微候群，均收集在本研究中。所有病患均接受傳統磁振造影檢查，其中有 10 位病患同時接受擴散加權磁振造影。 10 位病患有後續之磁振造影影像追蹤。此擴散加權磁振造影在 1 . ST 之磁振造影儀器下進行，使用一single - shot spin - echo echo - planar 之脈衝序列。有關病人之臨床資料以及初次及追蹤之神經學影像檢查發現，均在此研究中詳加紀錄，以作為比較。磁振造影對於後側可逆性腦病變徵候群之發現，通常病灶位於腦部皮質下白質為主之後循環區域。而少數病患之前側循環區域、腦幹•小腦、深部白質區域及視丘亦受到侵犯。傳統 T2 加權影像及 FLAIR 加權影像為高訊號表現。擴散加權影像顯示等訊號，並且有較高之擴散係數，此代表血管通透性引起之腦水腫。在追蹤過程中，大部份病患經及時適度針對後側可逆性腦病變微候群之原因治癒後，臨床症狀及原本病灶的不正常訊號會消失。本研究中只有一位病患在追蹤影像中，原本病灶形成細胞毒性水腫之腦梗塞。擴散加權影像可幫助提升傳統磁振造影來診斷後側可逆性腦病變徵候群，是一可行及有價值的輔助診斷檢查工具。

關鍵字

後側可逆性腦病變徵候群 ； 高血壓腦病變 ； 磁振造影 ； 擴散加權影像

並列摘要

Posterior reversible encephalopathy syndrome (PRES) is a potentially devastating neurologic syndrome, but timely treatment may lead to complete reversal of the disease course. We reviewed 12 cases of PRES and describe the clinical history and imaging findings, including conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and calculated apparent diffusion coefficient (ADC) maps, used to establish the diagnosis of PRES. Three male and nine female patients aged between 11 and 70 years (mean, 37 years) with clinical and imaging findings consistent with PRES were enrolled in the study. All patients had undergone conventional MRI and 10 had undergone additional DWI studies, Ten patients had follow-up MRI studies. DWI was performed using a 1.5T system with a single-shot spin-echo echo- planar pulse sequence. Initial and follow-up neuroimaging and clinical history were reviewed. Lesions were almost always present over the posterior circulation, mainly the parieto-occipital region, affecting primarily the white matter. The anterior circulation region, brainstem, cerebellum, deep cerebral white matter, and thalamus were also involved in five cases. Conventional MRI revealed hyperintensity on T2- weighted and fluid-attenuated inversion recovery images. DWI showed isointensity and increased signal intensity on ADC values in all cases, indicating vasogenic edema. Clinical and MRI follow-up showed that the symptoms and radiologic abnormalities could be reversed after appropriate treatment of the causes of PRES in most patients (9 of 10). In one patient, the ADC value was lower on follow-up images, indicating cytotoxic edema with ischemic infarct, DWI was a useful complement to MRI in the diagnosis of PRES.

並列關鍵字

posterior reversible encephalopathy syndrome ； hypertensive encephalopathy ； magnetic resonance imaging ； diffusion-weighted imaging