Brismar J, Gascon G G, von Steyern K V, Bohlega S
Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
AJNR Am J Neuroradiol. 1996 Apr;17(4):761-72.
To evaluate the progression of CT and MR changes of the brain in subacute sclerosing panencephalitis (SSPE) as a basis for assessing the effects of different types of therapy.
Fifty-two patients with SSPE were examined, 44 with MR imaging and 42 with CT of the brain on one or more occasions. A total of 92 MR and 67 CT studies were performed.
Correlation between the clinical status and the MR findings in admission was poor. Of 20 patients with clinically advanced disease, only 8 had marked MR abnormalities; 6 had normal or almost normal findings on MR examinations. Two of 4 patients with clinically mild disease had advanced MR changes. The progression of the MR findings appeared to follow a constant pattern. The earliest pathologic finding was focal, high-T2-intensity white matter changes; later atrophic changes followed. The atrophy lagged behind the white matter changes and was thus mild when white matter changes were moderate or severe. In the most advanced stage, when the patient was in a neurovegetative state, an almost total loss of white matter had usually taken place. At this stage, the corpus callosum was also thin. Basal ganglia changes, usually involving the putamina, were seen in one third of patients and cortical gray matter changes were seen in one fourth of patients examined with MR imaging. In 2 of 20 patients, MR changes regressed in parallel with clinical improvement following therapy, but in 5 patients clinical improvement was accompanied by progression of MR changes.
The progress of MR abnormalities seen in patients with SSPE seems to follow a constant pattern, but the severity of MR changes does not always correlate well with the clinical findings. Caution must therefore be used when evaluating the effects of therapy.
评估亚急性硬化性全脑炎（SSPE）患者脑CT和MR改变的进展情况，作为评估不同类型治疗效果的依据。
对52例SSPE患者进行检查，其中44例进行了一次或多次脑部MR成像检查，42例进行了脑部CT检查。共进行了92次MR检查和67次CT检查。
入院时临床状况与MR表现之间的相关性较差。20例临床病情较重的患者中，只有8例有明显的MR异常；6例MR检查结果正常或几乎正常。4例临床病情较轻的患者中有2例出现了进展性MR改变。MR表现的进展似乎遵循一种固定模式。最早的病理表现是局灶性、高T2信号的白质改变；随后出现萎缩性改变。萎缩落后于白质改变，因此在白质改变为中度或重度时萎缩较轻。在最晚期，当患者处于植物神经状态时，通常会出现几乎完全的白质丢失。此时，胼胝体也变薄。三分之一的患者可见基底节改变，通常累及壳核，四分之一接受MR成像检查的患者可见皮质灰质改变。20例患者中有2例在治疗后MR改变与临床改善同步消退，但有5例患者临床改善的同时MR改变却进展。
SSPE患者中所见的MR异常进展似乎遵循一种固定模式，但MR改变的严重程度并不总是与临床表现密切相关。因此，在评估治疗效果时必须谨慎。
