【摘要】 目的分析儿童后部可逆性脑病综合征(PRES)的MRI特征,探讨其发病机制。方法回顾性分析10例PRES的临床及影像资料,基础疾病包括肾病综合征5例,急性肾炎2例,重症肺炎伴高肾素性高血压1例,淋巴瘤化疗1例,噬血细胞性淋巴组织细胞增生症1例。10例中7例患儿血压有升高。所有患儿行MRI扫描,其中2例增强扫描,2例MR血管成像(MRA)。结果 MRI显示双侧枕顶叶(10例)、额叶(2例)、颞叶(2例)、基底节区(1例)及双侧小脑半球(1例)皮层及皮层下多发T1WI略低、T2WI高信号,4例DWI高信号,2例增强后轻度强化,1例MRA表现为基底动脉远端、左椎动脉狭窄。随访MRI显示病灶明显缩小或消失。结论 PRES影像特征为枕顶叶皮层及皮层下白质水肿,其发病机制复杂,现有理论不能完全解释所有影像表现。对有严重基础疾病的患儿应警惕PRES并及早行MRI检查。更多还原

【Abstract】 Objective To analyze the MRI features of posterior reversible encephalopathy syndromes(PRES)in children and to explore its possible pathologic mechanism.Methods The clinical and imaging data of 10patients with PRES were analyzed retrospectively.All cases had underlying diseases including 5cases of nephrotic syndrome,2cases of acute nephritis,1case of severe pneumonia complicated with high renin hypertension,1case of lymphoma chemotherapy and 1case of hemophagocytic lymphohistiocytosis.Of 10cases,7cases had hypertension.MR scanning was performed in all cases,in which 2cases underwent enhanced MR imaging and 2cases underwent MR angiography(MRA).Results MRI showed the lower signals on multiple T1W1and the high signals on T2W1in the cortical and subcortical regions of the bilateral occipital and parietal lobe(10cases),bilateral frontal lobe(2 cases),temporal lobe(2cases),basal ganglial area(1case)and bilateral cerebellar hemispheres(1case).The lesions presented as low signal on T1WI and high signal on T2WI and T2FLAIR images.4cases showed the high signal on DWI and 2cases showed mild enhancement after administration of gadalinium.MRA in 1case was manifested as stenosis of the distal end of the basilar artery and the left vertebral artery.The follow-up MRI demonstrated that the lesions were significantly diminished or disappeared. Conclusion The MRI image features of PRES are manifested by the white matter edema in the occipital lobe and patietal cortex and subcortex.Its pathogenesis is complex.The present theories can not entirely explain all the MRI findings.Children with serious underlying disease should be vigilant in PRES and the MRI examination should be early conducted.更多还原