Baum P A, Barkovich A J, Koch T K, Berg B O
Department of Radiology, University of California San Francisco.
AJNR Am J Neuroradiol. 1994 Aug;15(7):1275-83.
To review the frequency, distribution, and extent of deep gray matter disease in children with acute disseminated encephalomyelitis.
The MR examinations of 10 patients, who were discharged with the clinical diagnosis of acute disseminated encephalomyelitis between 1986 and 1992, were retrospectively reviewed. Locations of abnormal signal in the cerebral and cerebellar cortices, white matter, and deep gray matter nuclei were recorded. Precontrast and postcontrast images were compared, when available, to assess degree of enhancement (if any).
Six patients had foci of prolonged T2 relaxation in the deep gray matter, ranging in size from less than 1 cm to 4 cm. The caudate heads were involved in 4 patients, caudate body in 3, globus pallidus in 3, putamina in 3, and thalami in 4. In 1 patient, the thalami were involved nearly symmetrically, with mild mass effect. Asymmetric subcortical white matter involvement was present as well. Prolonged T2 relaxation was present within the cerebral cortex in 4 patients and was associated with subcortical white matter abnormality in 3 and more central white matter disease in 1. Nine of 10 patients demonstrated foci of T2 prolongation in white matter, most commonly involving the subcortical region, corona radiata, and centrum semiovale. Three patients also had periventricular foci. Of the 3 patients receiving gadolinium, one showed no enhancement. Two of the patients showed enhancement of some but not all lesions. One patient, who had normal brain MR findings and symptoms of myelopathy, underwent spine MR which demonstrated focal linear areas of T2 prolongation in the spinal cord at levels C-1 to C-2 and T-6.
Involvement of deep gray matter was common in our small series. The finding of T2 prolongation in these structures does not preclude the diagnosis of acute disseminated encephalomyelitis in the proper clinical setting. Because thalamic involvement is reported to be rare in multiple sclerosis, it may prove useful in distinguishing between acute disseminated encephalomyelitis and the initial presentation of multiple sclerosis.
回顾急性播散性脑脊髓炎患儿深部灰质病变的发生率、分布及范围。
回顾性分析1986年至1992年间临床诊断为急性播散性脑脊髓炎并出院的10例患者的磁共振成像（MR）检查结果。记录大脑和小脑皮质、白质及深部灰质核团中异常信号的位置。如有增强扫描，比较增强前后图像，以评估强化程度（如有）。
6例患者深部灰质出现T2弛豫时间延长灶，大小从小于1厘米至4厘米不等。4例累及尾状核头部，3例累及尾状核体，3例累及苍白球，3例累及壳核，4例累及丘脑。1例患者双侧丘脑几乎对称受累，有轻度占位效应。同时存在不对称的皮质下白质受累。4例患者大脑皮质出现T2弛豫时间延长，其中3例与皮质下白质异常有关，1例与更靠近中心的白质病变有关。10例患者中有9例白质出现T2延长灶，最常见于皮质下区域、放射冠和半卵圆中心。3例患者还出现脑室周围病灶。在接受钆剂增强扫描的3例患者中，1例无强化。2例患者部分而非全部病灶出现强化。1例脑MR检查结果正常但有脊髓病症状的患者接受了脊柱MR检查，结果显示C - 1至C - 2及T - 6水平脊髓出现局灶性T2延长线性区域。
在我们的小样本系列研究中，深部灰质受累较为常见。在适当的临床背景下，这些结构中出现T2延长并不排除急性播散性脑脊髓炎的诊断。由于据报道丘脑受累在多发性硬化中罕见，这可能有助于区分急性播散性脑脊髓炎和多发性硬化的初始表现。
