Ahn K J, You W J, Jeong S L, Lee J W, Kim B S, Lee J H, Yang D W, Son Y M, Hahn S T
Department of Radiology, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 62 Youido-Dong, Youngdeungpo-Gu, 150-713, Seoul, Korea.
Neuroradiology. 2004 Dec;46(12):978-83. doi: 10.1007/s00234-004-1276-1. Epub 2004 Nov 5.
Typically, reversible posterior leukoencephalopathy syndrome (RPLS) involves the parieto-occipital lobes. When regions of the brain other than the parieto-occipital lobes are predominantly involved, the syndrome can be called atypical RPLS. The purpose of this study is to find radiological and pathophysiological features of atypical RPLS by using diffusion-weighted imaging (D-WI). We retrospectively reviewed seven patients (two with eclampsia, one with cyclosporine neurotoxicity, and four with hypertensive encephalopathy) with atypical MR manifestations of RPLS. Changes in signal intensity on T2-weighted imaging (T2-WI) and D-WI, and ADC ratio, were analyzed. In patients with atypical manifestation of RPLS, high signal intensities on T2-WI were noted in the frontal lobe, basal ganglia, thalamus, brainstem, and subcortical white matter in regions other than the parieto-occipital lobes. These areas of increased signal intensities on T2-WI showed increased ADC values, representing vasogenic edema in all seven patients. This result should be very useful in differentiating atypical RPLS from other metabolic brain disorders that affect the same sites with cytotoxic edema.
通常，可逆性后部白质脑病综合征（RPLS）累及顶枕叶。当主要累及顶枕叶以外的脑区时，该综合征可称为非典型RPLS。本研究的目的是通过使用弥散加权成像（D-WI）来发现非典型RPLS的影像学和病理生理学特征。我们回顾性分析了7例具有非典型RPLS磁共振表现的患者（2例子痫、1例环孢素神经毒性、4例高血压脑病）。分析了T2加权成像（T2-WI）和D-WI上的信号强度变化以及表观扩散系数（ADC）比值。在非典型RPLS表现的患者中，在顶枕叶以外区域的额叶、基底节、丘脑、脑干和皮质下白质T2-WI上可见高信号强度。T2-WI上这些信号强度增加的区域ADC值升高，表明所有7例患者均存在血管源性水肿。该结果对于将非典型RPLS与其他影响相同部位并伴有细胞毒性水肿的代谢性脑部疾病进行鉴别非常有用。
