·论 著·

    红斑狼疮性脑病的MRI诊断

    王桂华1

    ,伍炳华2

    ,莫永丰2

    (1.广州市第一人民医院放射科 广东 广州 510180 ;2.湖南省益阳市卫校附属医院 湖南 益阳 410001)

    【摘 要】 目的:探讨红斑狼疮性脑病的MRI表现及其临床诊断价值。方法:回顾性分析17例系统性红斑狼疮性脑损害

    患者的MRI图像。全部病例均符合系统性红斑狼疮诊断 ,临床有神经、精神异常而行颅脑MRI检查。结果:红斑狼疮性

    脑病的MRI检查阳性率为88. 2 %(15/ 17) 。主要MRI表现包括:弥漫性白质或灰质异常信号(13/ 17) ;局灶性异常信号(2/ 17) ;

    病灶无强化或边缘轻微强化;基底节脑梗塞;病灶边界清晰 ,周围无水肿带 ,亦无占位效应 ,全部病例无脑萎缩表现。结

    论:MRI检查可显示红斑狼疮性脑病患者脑内病变的位置、数目、大小、范围 ,对指导治疗及评价疗效有重要意义。

    【关键词】 系统性红斑狼疮;脑病;磁共振成像

    中图分类号:R593. 24 +

    1 ;R445. 2 文献标识码:A 文章编号:1006 - 9011(2004) 10 - 0787 - 03

    MRI diagnosis of cerebral lesions in patients with systemic lupus erythematosus WANG Gui2hua , WU Bing2hua , MO Yong2 feng.

    Department of Radiology , The First Hospital of Guangzhou City of Guang Dong Province , Guangzhou 510180 , China

    【Abstract】 Objective :To evaluate the magnetic resonance (MR) imaging appearances of cerebral lesions in patients with systemic lu 2

    pus erythematosus (SLE) and the utility of MR imaging in diagnosing the brain lesions in SLE.Methods :MRI findings of 17 cases with

    SLE were analyzed retrospectively. The diagnosis in all patients fit in with the criteria of system lupus erythematosus.MRI scanning was

    performed in those patients who experienced neuropsychic symptoms.Results :Abnormal MRI signs were seen in 15 cases (88. 2 %) , in2

    cluding : ① Diffuse abnormal MR signal intensities were revealed in the white or gray matter (13/ 17) ; ②Focal abnormal signals were de2

    tected (2/ 17) ; ③There were no or mild enhancement in lesions ;④Infarctions in region of basal ganglion ; ⑤The lesion margins were

    clear , and no brain atrophy demonstrated.Conclusion :MRI can not only reveal the cerebral lesion location , number , size and area in pa 2

    tients with SLE , but also be of importance in guiding the therapy and evaluating the response to treatment .

    【Key words】 Brain diseases ;Systemic lupus erythematosus ;Magnetic resonance imaging

    系统性红斑狼疮( systemic lupus erythematosus ,SLE)是一种常见的自身免疫性疾病 ,约 50 %～75 %

    合并中枢神经系统受累 ,尤其是导致脑损害 —即红

    斑狼疮性脑病 ( lupus erythematosus encephalopathy ,LEE)

    [1 ,2 ]。国内外有关 SLE的临床及发病机制的报

    道较多见 ,目前主要依靠实验室与影像学检查来确

    诊 ,但国内该病的 MRI 诊断资料报道较少。由于

    MRI对脑部病变的显示具有很高的敏感性 ,已成为

    影像学检查的主要手段[3 ]。笔者收集了经临床证实

    的LEE 17例 ,对其MRI表现 ,分析报道如下。

    1 材料与方法

    1. 1 一般资料

    本组17例 ,男2例 ,女15例。年龄2～48岁 ,平

    均年龄30. 6岁。全部病例均符合 SLE诊断标准 ,以

    出现神经精神异常 1～6 个月而行颅脑 MRI 检查。

    作者简介:王桂华(1972 - ) ,男,湖南省益阳市人,主治医师,硕

    士学位,主要从事腹部影像学诊断

    临床症状包括头痛(10例) ,癫痫发作(6 例) ,精神兴

    奋或抑郁(5 例) ,肢体活动受限(4 例) 。12 例合并

    神经系统外症状 ,如发热、皮肤损害、狼疮性肾炎 ......