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目的提高对可复性后部脑病综合征(PRES)的MRI诊断及鉴别诊断的认识。资料与方法回顾性分析8例经临床证实的PRES患者的临床及MRI表现。8例均行MRI检查,其中3例行钆喷替酸葡甲胺(Gd-DTPA)增强扫描,2例行磁共振血管造影(3D-TOF MRA)检查,1例行增强磁共振静脉成像(CE-MRV)检查,6例行扩散加权成像(DWI)。结果MRI显示病灶基本上呈双侧对称性分布,6例位于顶、枕叶皮层及皮层下,2例累及脑干。T1WI呈等或略低信号,T2WI及液体衰减反转恢复(FLAIR)呈高信号,注射Gd-DTPA后无明显异常对比强化,MRA未见明显异常,DWI显示病变扩散受限呈高信号,ADC图呈高信号或为正常。7例经对症处理后多次复查示所有病灶几乎完全吸收消失,临床症状好转;1例因多系统衰竭死亡。结论MRI对PRES的病变范围显示清楚,具有一定的特征性,多种MR检查方法并结合治疗后复查可以明确该病的诊断。
Objective To improve the diagnosis and differential diagnosis of recurrent posterior encephalopathy syndrome (PRES). Materials and Methods The clinical and MRI findings of 8 clinically confirmed PRES patients were retrospectively analyzed. 8 patients underwent MRI examination. Three patients underwent enhanced Gd-DTPA scan, two underwent MR angiography (3D-TOF MRA) and one underwent MR venography CE-MRV), and diffusion-weighted imaging (DWI) in 6 cases. Results MRI showed that the lesions were basically bilateral symmetry distribution, 6 cases located in the top, occipital cortex and cortex, 2 cases involving the brain stem. T1WI was equal or slightly lower signal, T2WI and fluid attenuation inversion recovery (FLAIR) showed a high signal, injection of Gd-DTPA no significant abnormal contrast enhancement, MRA no obvious abnormalities, DWI showed limited diffusion of lesions was high signal, ADC The graph shows a high signal or is normal. Seven cases of symptomatic treatment after repeated examination showed that almost all of the lesions disappear, the clinical symptoms improved; one case of death due to multiple system failure. Conclusions MRI shows the scope of PRES lesions clearly, with certain characteristics, a variety of MR examination combined with post-treatment review can confirm the diagnosis of the disease.