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目的探讨线粒体脑肌病伴高乳酸血症和卒中样发作(MELAS)的神经影像学特点。方法收集2003年10月至2006年7月间入住我院神经内科的22例 MELAS 患者的资料,并对头颅CT、MRI 平扫及增强、MRA、磁共振波谱(MRS)等影像学检查的结果进行分析。结果 22例患者中21例影像学检查结果为阳性,其病灶9例位于单侧,12例位于两侧半球。主要累及枕、顶、颞、额叶,头颅 MRI 表现为 T_1WI 低信号,T_2WI、FLAIR 像高信号。其中16例 MRI 增强中12例病灶被不同程度强化。3例表现较为特殊,1例患者影像学表现为软化灶样改变,1例伴有 Fahr 综合征样改变,1例MRI 增强见强血管反应。MRS 表现为 N-乙酰天冬氨酸峰降低及高乳酸峰。结论虽然 MELAS 神经影像学特点复杂多样,但有其特征性的表现,如病灶多位于皮质及皮质下,新旧病灶反复交替等,因此,可利用 CT、MRI、MRS 等影像学方法辅助该病的诊断。
Objective To investigate the neuroimaging characteristics of mitochondrial encephalomyopathy with hyperlactic acidosis and stroke-like episode (MELAS). Methods The data of 22 MELAS patients admitted to Department of Neurology in our hospital from October 2003 to July 2006 were collected. The results of imaging examination such as cranial CT, MRI plain scan and contrast enhancement, MRA and magnetic resonance spectroscopy (MRS) Analyze. Results Twenty-one of the 22 patients were positive in imaging examination. Nine lesions were located on the unilateral side and 12 on the bilateral hemispheres. Mainly involving the occipital, top, temporal, frontal lobe, head MRI showed T_1WI low signal, T_2WI, FLAIR like high signal. Of the 16 cases, 12 lesions were enhanced to varying degrees in MRI enhancement. Three cases showed a rather special appearance. One case showed a change in the appearance of soft tissue, one case of Fahr syndrome-like change, and one case of MRI showed strong vascular reaction. MRS showed decreased N-acetyl aspartate peak and high lactate peak. CONCLUSIONS Although the features of MELAS neuroimaging are complex and diverse, they have their characteristic features such as the lesions mostly located in the cortex and cortex, the repeated alternation of old and new lesions, etc. Therefore, CT, MRI, MRS and other imaging methods can be used to assist the disease diagnosis.