神经梅毒MRI表现及血流灌注研究
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摘要
目的提高对神经梅毒MRI特点的认识,并探讨MR动脉自旋标记(ASL)技术在神经梅毒诊断和治疗中的作用。资料与方法回顾性分析2015年11月—2016年11月于苏北人民医院确诊为神经梅毒的13例患者(研究组),其中男9例,女4例,年龄23～65岁;选取20例正常人为对照组,行常规头颅MR检查及ASL扫描。分别在双侧额叶、顶叶、颞叶、枕叶、小脑半球皮层勾画感兴趣区测量脑血流量(CBF)。评价两组各部位CBF的差别。研究组中6例患者在开始治疗后1周到2个月内复查常规头颅MR及ASL扫描,比较治疗前后MRI表现及CBF的变化。结果 13例患者共发现21处病灶,其中额叶5处,颞叶8处,半卵圆中心、顶叶、枕叶和基底节区各2处,呈散在、多发或大片状异常信号。研究组额叶、顶叶及颞叶CBF值分别为(63.22±5.41)ml/(min·100 g)、(65.63±5.12)ml/(min·100 g)和(72.12±4.81)ml/(min·100 g),均高于对照组相应部位[(42.67±4.89 ml/(min·100 g)、(43.76±5.43)ml/(min·100 g)和(47.27±5.15)ml/(min·100 g),P<0.05]。6例患者正规治疗后复查,原CBF值降低的部位现未见明显变化,而原CBF值升高的部位现减低。结论神经梅毒的MRI表现多样,无特异性。神经梅毒ASL反映脑血流灌注改变和神经梅毒疗效的评价。
Purpose To improve the understanding of MRI features of neurosyphilis, and to explore the role of magnetic resonance arterial spin labeling(ASL) in the diagnosis and treatment of neurosyphilis. Materials and Methods A retrospective analysis was performed on 13 patients(study group) diagnosed as neurosyphilis in Northern Jiangsu People's Hospital from November 2015 to November 2016, including 9 males and 4 females, aged 23-65. 20 normal subjects were included in the control group, routine brain MRI and ASL scan were performed. Regions of interest were delineated and cerebral blood flow(CBF) were measured at bilateral frontal lobes, parietal lobe, temporal lobe, occipital lobe, and cerebellar hemisphere cortex, respectively. The difference in CBF between the two groups was evaluated. 6 patients in the study group underwent routine brain MRI and ASL scan for reexamination within 1 week to 2 months after starting treatment, and MRI manifestations and CBF changes before and after treatment were compared. Results Totally 21 lesions were found in 13 patients, including 5 at frontal lobe, 8 at temporal lobe, and 2 at centrum semiovale, parietal lobe, occipital lobe and basal ganglia region, respectively; displaying scattered, multiple or massive abnormal signals. The CBF values of frontal, parietal and temporal lobe in the study group were(63.22±5.41) ml/(min·100 g),(65.63±5.12) ml/(min·100 g) and(72.12±4.81) ml/(min·100 g), respectively; all higher than the corresponding parts of the control group [(42.67±4.89) ml/(min·100 g),(43.76±5.43) ml/(min·100 g) and(47.27±5.15) ml/(min·100 g), respectively, P<0.05]. Six patients were reexamined after regular treatment, and no significant changes was spotted in the part where original CBF value decreased. However, decrease was detected in the part where the original CBF value raised. Conclusion MRI manifestations of neurosyphilis are diverse and non-specific. Neurosyphilis ASL reflects the evaluation of cerebral blood perfusion changes and efficacy of neurosyphilis.
Purpose To improve the understanding of MRI features of neurosyphilis, and to explore the role of magnetic resonance arterial spin labeling(ASL) in the diagnosis and treatment of neurosyphilis. Materials and Methods A retrospective analysis was performed on 13 patients(study group) diagnosed as neurosyphilis in Northern Jiangsu People's Hospital from November 2015 to November 2016, including 9 males and 4 females, aged 23-65. 20 normal subjects were included in the control group, routine brain MRI and ASL scan were performed. Regions of interest were delineated and cerebral blood flow(CBF) were measured at bilateral frontal lobes, parietal lobe, temporal lobe, occipital lobe, and cerebellar hemisphere cortex, respectively. The difference in CBF between the two groups was evaluated. 6 patients in the study group underwent routine brain MRI and ASL scan for reexamination within 1 week to 2 months after starting treatment, and MRI manifestations and CBF changes before and after treatment were compared. Results Totally 21 lesions were found in 13 patients, including 5 at frontal lobe, 8 at temporal lobe, and 2 at centrum semiovale, parietal lobe, occipital lobe and basal ganglia region, respectively; displaying scattered, multiple or massive abnormal signals. The CBF values of frontal, parietal and temporal lobe in the study group were(63.22±5.41) ml/(min·100 g),(65.63±5.12) ml/(min·100 g) and(72.12±4.81) ml/(min·100 g), respectively; all higher than the corresponding parts of the control group [(42.67±4.89) ml/(min·100 g),(43.76±5.43) ml/(min·100 g) and(47.27±5.15) ml/(min·100 g), respectively, P<0.05]. Six patients were reexamined after regular treatment, and no significant changes was spotted in the part where original CBF value decreased. However, decrease was detected in the part where the original CBF value raised. Conclusion MRI manifestations of neurosyphilis are diverse and non-specific. Neurosyphilis ASL reflects the evaluation of cerebral blood perfusion changes and efficacy of neurosyphilis.
引文
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[2]刘增礼,施辛,吴锦昌,等.早期梅毒患者的脑血流灌注显像.中华核医学杂志,2003,23(3):158-159.
[3]向涛,李国良,肖岚,等.伴颞叶病变的神经梅毒的MRI特点.中华放射学杂志,2014,48(3):248-249.
[4]毕军焱,王海宝,余永强.静息态fMRI评价神经梅毒脑功能改变.中国医学影像技术,2015,32(4):523-526.
[5]Mimura M,Kato M,Ishii K,et al.A neuropsychological and neuroimaging study of a patient before and after treatment for paretic neurosyphilis.Neurocase,1997,3(4):275-287.
[6]Kitabayashi Y,Ueda H,Narumoto J,et al.Cerebral blood flow changes in general paresis following penicillin treatment:a longitudinal single photon emission computed tomography study.Psychiatry Clin Neurosci,2002,56(1):65-70.
[7]Xiang T,Li GL,Xiao L,et al.Neuroimaging of six neurosyphilis cases mimicking viral encephalitis.J Neurol Sci,2013,334(1/2):164-166.
[8]Bash S,Hathout GM,Cohen S.Mesiotemporal T2-weighted hyperintensity:neurosyphilis mimicking herpesencephalitis.Am J Neuroradiol,2001,22(22):314-316.
[9]Yao YR,Huang EQ,Xie BD,et al.Neurosyphilis presenting with psychotic symptoms and status epilepticus.Neurol Sci,2012,33(1):99-102.
[10]陈爽,钱建国,冯晓源.脑膜血管型神经梅毒的MRI表现.中华放射学杂志,2005,39(2):148-150.