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目的 观察鼻咽癌放射治疗后放射性脑病 (REP)的MRI表现并探讨其诊断价值。方法 对 38例具有临床表现、MRI诊断、随诊观察或手术病理证实的鼻咽癌放射治疗后REP病人的MRI和临床资料进行回顾性分析。结果 REP的发生以颞叶最为常见 ,占所有检出病灶的 90 .7% ,病变可累及双侧或单侧。其典型表现为 :(1)指状水肿并局灶性脑坏死 :T1WI为指状低信号 ,T2 WI为高信号 ,T1WI+Gd DTPA增强扫描可见位于颞叶底部的脑回状或不规则环形强化 ,强化灶的上界多在颅底线上 1.5～ 3.0cm ,强化灶周围可见大片水肿。病灶大者 (13.2 % )可有占位效应。 (2 )囊性液化 (脑软化 ) :T1WI为边界清楚类圆形脑脊液样低信号 ,T2 WI为高信号 (1个病灶为低信号 ) ,T1WI+Gd DTPA增强扫描无强化或囊壁有浅淡强化 ,病灶上界亦位于颞叶底部颅底线上 3.0cm以内。无占位效应。脑干受损者 5例 (2例同时有颞叶病灶 )主要累及脑桥 ,占 9.3 %。T1WI为低信号或等信号 ,T2 WI为高信号 ,T1WI+Gd DTPA增强扫描可见点状或不规则环状强化 ,病灶均 <2cm ,周围水肿轻 ,无占位效应。结论 鼻咽癌放射治疗后REP的MRI表现有一定的特征性 ,可作为REP诊断的主要方法
Objective To observe the MRI manifestations of nasopharyngeal carcinoma after radiation therapy and discuss its diagnostic value. Methods The MRI and clinical data of 38 patients with REP after radiotherapy of nasopharyngeal carcinoma with clinical manifestations, MRI diagnosis, follow-up observation or surgical pathology were retrospectively analyzed. Results The most common occurrence of REP occurred in the temporal lobe, which accounted for 90.7% of all lesions detected. The lesions could involve bilateral or unilateral. The typical manifestations are: (1) finger edema and focal brain necrosis: T1WI finger low signal, T2 WI high signal, T1WI + Gd DTPA enhanced scan located in the bottom of the temporal lobe of the brain back or irregular ring Strengthen, strengthen the upper limit of the stove more in the skull at the line on the line 1.5 ~ 3.0cm, large lesions around the visible edema. Large lesions (13.2%) may have a placeholder effect. (2) cystic liquefaction (brain softening): T1WI is a clear class of circular cerebrospinal fluid-like low signal, T2 WI is high signal (1 lesion is low signal), T1WI + Gd DTPA enhanced scan without enhancement or shallow wall Light enhancement, upper lesion is also located at the bottom of the temporal lobe skull base line within 3.0cm. No placeholder effect. 5 cases of brain stem damage (2 cases with temporal lobe lesions) mainly involving the pons, accounting for 9.3%. T1WI is low signal or equal signal, T2WI is high signal, T1WI + Gd DTPA enhanced scan visible punctate or irregular ring enhancement, lesion were <2cm, around the edema, no placeholder effect. Conclusion The MRI findings of REP after nasopharyngeal carcinoma have certain characteristics and can be used as the main method of REP diagnosis