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目的:探讨扩散成像(DWI、DTI)和磁共振波谱(1H-MRS)对MELAS患者的诊断价值。材料和方法:采用3.0T磁共振,对5例经病理证实的MELAS患者进行常规磁共振及DWI、DTI和1H-MRS检查。结果:5例MELAS患者常规磁共振可见大脑皮层多发脑回状长T1长T2及高FLAIR异常信号,增强扫描无强化,病灶具有游走和复发特点。DWI病变区呈稍高信号,ADC图呈稍高或稍低或混杂信号;DTI显示白质纤维信号减低;1H-MRS可见NAA峰降低,高大Lac峰出现。病灶区与对侧正常区比较ADC值增高(P<0.05),FA值降低(P<0.01),NAA/Cr降低(P<0.05),Lac/Cr明显增高(P<0.01)。结论:常规磁共振发现大脑皮层反复出现的多发游走性无强化病灶,要考虑到MELAS型线粒体脑肌病的可能性,DWI结合ADC图有助于明确MELAS的病理损害性质,DTI可直观显示白质纤维破坏程度,1H-MRS检测到异常高大Lac峰是支持MELAS的重要辅助依据。
Objective: To investigate the diagnostic value of diffusion imaging (DWI, DTI) and magnetic resonance spectroscopy (1H-MRS) in patients with MELAS. MATERIALS AND METHODS: Conventional MR and DWI, DTI and 1H-MRS examinations were performed on 5 pathologically confirmed MELAS patients using 3.0T magnetic resonance imaging. Results: Five patients with MELAS showed common cerebellar recurrent cerebral recurrent long T1 long T2 and high FLAIR abnormal signals in conventional magnetic resonance imaging. There was no enhancement in enhanced scan, and the lesions had the characteristics of walking and recurrence. DWI lesion showed a slightly higher signal, ADC showed slightly higher or lower or mixed signal; DTI showed white matter fiber signal decreased; 1H-MRS visible NAA peak, high Lac peak. The ADC value was increased (P <0.05), FA value was decreased (P <0.01), NAA / Cr was decreased (P <0.05) and Lac / Cr was significantly increased in lesion area and contralateral normal area (P <0.01). CONCLUSIONS: Conventional magnetic resonance (MR) findings show recurrent multiple cerebral motility without intensive lesions. The possibility of MELAS-type mitochondrial encephalomyopathy should be taken into consideration. DWI combined with ADC maps can help clarify the pathological features of MELAS. DTI can be directly visualized The degree of white matter fiber destruction, 1H-MRS detected abnormally high Lac peak is an important auxiliary support MELAS.