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目的探讨MRI和MRV在妊娠相关性脑静脉及静脉窦血栓形成(CVST)和可逆性后部白质脑病综合征(RPLS)鉴别诊断中的价值。方法回顾性分析3例妊娠相关性CVST和6例重度子痫前期、子痫发生RPLS患者的影像学资料。所有患者均行MRI和DSA检查,其中7例患者行MRV检查。结果 3例CVST患者中,1例孤立性大脑上静脉前组血栓形成,MRI表现为相应部位T1WI低、等信号,T2WI、FLAIR等、稍高信号,DWI为等、高信号,ADC图为低、稍高信号;2例横窦血栓形成,表现为双侧枕叶皮质、皮质下白质片状T1WI低信号,T2WI、FLAIR高信号,DWI、ADC高信号,可不对称性地累及顶叶、小脑半球,MRV与DSA检查结果相符。6例RPLS患者MRI显示双侧顶、枕叶皮质、皮质下白质多发性、斑片状、对称性病变,部分严重患者大脑半球呈弥漫性、大片状受累,表现为T1WI低信号,T2WI、FLAIR高信号,DWI、ADC高信号;1例患者MRV检查示左侧横窦未显影,DSA检查示左侧横窦通畅。结论横窦血栓形成和RPLS患者MRI均显示血管源性脑水肿,两者脑水肿主要发生于双侧枕、顶叶,但前者范围较局限,后者范围更广泛,可累及基底节、额叶、颞叶。RPLS患者MRV检查可有假阳性,DSA是鉴别两者的重要检查方法。
Objective To investigate the value of MRI and MRV in the differential diagnosis of pregnancy related cerebral venous and sinus thrombosis (CVST) and reversible posterior leukoencephalopathy syndrome (RPLS). Methods Three cases of pregnancy-related CVST and 6 cases of severe preeclampsia and eclampsia with RPLS were retrospectively analyzed. All patients underwent MRI and DSA examination, of which 7 patients underwent MRV examination. Results Among the 3 patients with CVST, one isolated thoracic anterior cerebral artery thrombosis showed low T1WI signal, T2WI signal and FLAIR signal on the MRI. , Slightly higher signal; 2 cases of transverse sinus thrombosis, manifested as bilateral occipital cortical, subcortical white matter T1WI low signal, T2WI, FLAIR high signal, DWI, ADC high signal asymmetry can involve the parietal lobe, cerebellum Hemisphere, MRV and DSA test results. 6 cases of RPLS MRI showed bilateral parietal, occipital cortex, subcortical white matter of multiple, patchy, symmetrical lesions, some patients with severe hemispheres were diffuse, lamellar involvement, manifested as T1WI low signal, T2WI, FLAIR high signal, DWI, ADC high signal; MRV examination showed one case of left lateral sinus was not developed, DSA showed left transverse sinus patency. Conclusions Both transverse sinusoidal thrombosis and MRI of RPLS patients showed vasogenic brain edema. Both cerebral edema mainly occurred in the bilateral occipital and parietal lobe, but the former range was more limited. The latter range was broader and could involve the basal ganglia and the frontal lobe ,Temporal lobe. MRV examination of patients with RPLS may have false positives, DSA is to identify the two important methods of inspection.