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目的总结可逆性后部脑病综合征(reversible posterior encephalopathy syndrome,RPES)的临床特征及影像学表现特点。方法回顾性分析经临床随访证实12例RPES患者的CT和MRI影像资料,3例行CT平扫检查,其中2例加行CT增强扫描;3例行MRI平扫;6例同时行CT和MRI检查。结果 CT和/或MRI检查示病变均呈多发性,累及双侧枕叶12例,顶叶9例,颞叶4例,额叶2例,基底节区3例,小脑2例,脑干3例;除1例双侧顶叶病变伴发左侧颞叶受累,余病变均呈双侧对称性。CT表现为受累区域皮层及皮层下多发片状低密度影,边界不清;2例CT增强扫描病变均未见强化。MRI表现为受累区域脑回样或大片状T1WI等信号或低信号、T2WI高信号;快速液体衰减反转恢复序列显示病变高信号更清晰。10例治疗1~8周行CT或MRI复查,9例病灶明显吸收或消失,1例病变进展。结论 RPES具有特征性影像学表现,结合临床病史及症状易于确诊;影像学表现不典型者需在短期内复查,与其他疾病鉴别。
Objective To summarize the clinical features and imaging features of reversible posterior encephalopathy syndrome (RPES). Methods The CT and MRI data of 12 cases of RPES confirmed by clinical follow-up were retrospectively analyzed. Three cases were examined by CT plain scan, 2 cases were treated with CT enhanced scan, 3 cases were scanned by MRI, 6 cases were performed CT and MRI an examination. Results CT and / or MRI showed lesions were multiple, involving bilateral occipital in 12 cases, 9 cases of parietal lobe, temporal lobe in 4 cases, frontal lobe in 2 cases, basal ganglia in 3 cases, cerebellum in 2 cases, brain stem 3 Cases; except one case of bilateral parietal lobe lesions associated with left temporal lobe involvement, the remaining lesions showed bilateral symmetry. CT showed the affected area cortical and subcortical multiple low-density film flaps, the border is unclear; 2 cases of CT enhanced scanning lesions were not enhanced. MRI showed lesions or bradyarrhetic areas such as large T1WI signal or low signal, T2WI high signal; fast fluid attenuation reversal recovery sequence showed lesions higher signal clearer. Ten cases were treated by CT or MRI for 1 to 8 weeks, 9 cases were obviously absorbed or disappeared, and 1 case progressed. Conclusion RPES has characteristic imaging findings, which are easy to diagnose with clinical history and symptoms. Patients with atypical radiological manifestations should be reviewed in a short period of time and differentiated from other diseases.