Department of Neurology, the Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
Department of Neurology, the Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
J Clin Neurosci. 2021 Jan;83:125-127. doi: 10.1016/j.jocn.2020.11.012. Epub 2020 Nov 24.
Spontaneously disappearing lesions on magnetic resonance imaging (MRI) has been described in primary central nervous system lymphoma. In this case, we report our experience of spontaneously changing MRI findings of primary central nervous system vasculitis (PCNSV) confirmed histopathologically. A 69-year-old man presented with sudden unsteady gait. Fluid-attenuated inversion recovery (FLAIR) images showed high-intensity areas in the right deep white matter. Contrast-enhanced T1-weighted MRI demonstrated a nodular lesion in the white matter of the left occipitoparietal lobe. On repeat MRI 7 days later, FLAIR hyperintense lesions had spontaneously disappeared and contrast-enhanced lesions had progressed, with new contrast lesions in the right corpus callosum. Repeat MRI 14 days after admission demonstrated contrast-enhancing lesions either increased or decreased in intensity in both occipitoparietal lobes. Contrast-enhancing lesions were therefore biopsied. Histopathological examination revealed vasculitis with fibrinoid necrosis. PCNSV was diagnosed without any signs of inflammation in blood vessels other than cerebral blood vessels. Spontaneously changing MRI findings may play an important role in diagnosing PCNSV.
磁共振成像（MRI）上的自发性消失病变已在原发性中枢神经系统淋巴瘤中描述过。在本病例中，我们报告了经组织病理学证实的原发性中枢神经系统血管炎（PCNSV）的 MRI 表现自发变化的经验。一名 69 岁男性因突发步态不稳就诊。液体衰减反转恢复（FLAIR）图像显示右深部白质有高信号区。增强 T1 加权 MRI 显示左枕顶叶白质有结节状病变。重复 MRI 检查 7 天后，FLAIR 高信号病变已自发消失，增强病变进展，右侧胼胝体出现新的增强病变。入院后 14 天再次 MRI 显示双侧枕顶叶的增强病变的强度增加或减少。因此对增强病变进行了活检。组织病理学检查显示伴有纤维蛋白样坏死的血管炎。PCNSV 的诊断依据是除脑血管外，其他血管没有炎症迹象。MRI 表现的自发性变化可能对诊断 PCNSV 具有重要作用。
