摘要:
目的 探讨急性间歇性血卟啉病并发神经系统损害的MRI表现及鉴别诊断.方法 对临床确诊的10例急性间歇性血卟啉病并发神经系统损害的患者进行MRI检查,观察和分析病变的发生部位、分布及信号特点.结果 10例患者MR平扫所有病变的发生部位及MR信号表现一致,病变的具体部位为:双侧顶枕叶6例,双侧枕叶2例,双侧额顶叶1例,双侧额顶枕叶1例;累及皮质3例,皮层下白质10例,不累及神经核团.病变呈对称性分布7例,不完全对称3例.病变平扫T1WI呈边界略模糊的低或稍低信号,T2WI呈较高信号,FLAIR呈高信号.DWI病变呈低信号9例,呈等信号1例,表观扩散系数(ADC)图呈高信号10例.增强扫描病变无强化.4周后患者临床症状全部消失,复查颅脑MRI,病变完全消失8例,范围明显缩小2例.结论 MR扫描,尤其是弥散加权序列(DWI),对急性间歇性血卟啉病并发神经系统损害具有重要的诊断价值,结合患者临床资料,可作出明确诊断.%Objective To determine the MRI findings and differential diagnosis of actuc intermittent porphyryia complicated with the nervous system damage. Methods Ten patients who were clinically diagnosed acute intermittent porphyryia complicated with nervous system damage were performed MRI examination. The occurrence of the lesion location, distribution, and signal characteristics were observed and analysed. Results The location of all lesions and MR signal characteristics in the ten patients arc the same. The exact location of the lesions were as follows: bilateral parietal occipital in 6 cases, 2 cases of bilateral occipital, 1 case of bilateral frontal and parietal lobes, 1 case of bilateral frontal, parietal and occipital lobe; 3 cases involving the cortex, 10 cases of subcortical white matter, not involving the nucleus. The lesions were symmetrically distributed in 7 cases. 3 cases were not symmetrically distributed. On T1WI, the lesions showed low or slightly low signal intensity with fuzzy edge. The lesions showed high signal on T2 WI and FLAIR. On diffusion weighted imaging(DWI) ,9 cases showed low signal intensity, 1 case showed iso signal intensity. 10 cases showed high signal intensity on apparent diffusion coefficient (ADC) map. All the lesions showed no enhancement. The clinical symptoms disappeared 4 weeks later. Review brain MRI, lesions completely disappeared in 8 cases, the lesion range significantly narrowed in 2 cases. Conclusion MRI, especially DWI plays an important role in the diagnosis of acute intermittent porphyria complicated damage to the nervous system. Combined with clinical data, definite diagnosis can be made.