切换至 "中华医学电子期刊资源库"

中华脑科疾病与康复杂志(电子版) ›› 2021, Vol. 11 ›› Issue (02) : 105 -108. doi: 10.3877/cma.j.issn.2095-123X.2021.02.009

短篇论著

抗NMDAR脑炎的头颅MRI影像特征分析
姚东陂1, 刘鹏1, 朱吉强1, 张建林1, 郑雪燕1, 孙千贺1, 王红欣2,()   
  1. 1. 100122 北京朝阳中西医结合急诊抢救中心神经内二科
    2. 100122 北京,北京朝阳急诊抢救中心放射科
  • 收稿日期:2020-03-06 出版日期:2021-04-15
  • 通信作者: 王红欣

Analysis of head MRI imaging features of anti-NMDAR encephalitis

Dongpo Yao1, Peng Liu1, Jiqiang Zhu1, Jianlin Zhang1, Xueyan Zheng1, Qianhe Sun1, Hongxin Wang2,()   

  1. 1. Department of Neurology, Beijing Chaoyang Integrative Medicine Emergency Medical Center, Beijing 100122, China
    2. Department of Radiology, Beijing Chaoyang Emergency Medical Center, Beijing 100122, China
  • Received:2020-03-06 Published:2021-04-15
  • Corresponding author: Hongxin Wang
引用本文:

姚东陂, 刘鹏, 朱吉强, 张建林, 郑雪燕, 孙千贺, 王红欣. 抗NMDAR脑炎的头颅MRI影像特征分析[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(02): 105-108.

Dongpo Yao, Peng Liu, Jiqiang Zhu, Jianlin Zhang, Xueyan Zheng, Qianhe Sun, Hongxin Wang. Analysis of head MRI imaging features of anti-NMDAR encephalitis[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(02): 105-108.

目的

探讨抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的头颅MRI影像特征。

方法

回顾性分析自2018年12月至2020年6月于北京朝阳中西医结合急诊抢救中心神经内二科诊治的12例抗NMDAR脑炎患者的一般资料及头颅MRI影像结果。

结果

12例患者头颅MRI影像结果:正常者4例(33.3%),异常者8例(66.7%);病灶呈单发或多发,片状或斑片状,边界模糊。病变部位:颞叶内侧6例(75.0%)、岛叶4例(50.0%)、额叶3例(37.5%)。异常序列:T1WI低信号者2例(25.0%)、T2WI高信号者6例(75.0%)、FLAIR高信号者8例(100%)、DWI高信号者3例(37.5%);有强化者3例(37.5%),具体表现为病变区点状、片絮状强化,部分软脑膜及邻近血管强化。

结论

头颅MRI影像表现虽不能作为诊断抗NMDAR脑炎的特异性指标,但对病变出现在颞叶内侧和(或)岛叶部位、呈片状或斑片状、边界模糊、FLAIR和(或)T2WI高信号、部分有强化时,应高度警惕抗NMDAR脑炎的可能。

Objective

To explore the characteristics of head MRI of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.

Methods

The general data and head MRI results of 12 patients with anti-NMDAR encephalitis who were diagnosed and treated in the Neurology Department of Beijing Chaoyang Integrative Medicine Emergency Medical Center from December 2018 to June 2020 were collected and retrospectively analyzed.

Results

Head MRI results of the 12 patients: normal in 4 cases (33.3%), abnormal in 8 cases (66.7%), the lesions were single or multiple, flaky or patchy, with blurred borders. Lesion location: medial temporal lobe 6 cases (75.0%), insular lobe 4 cases (50.0%), frontal lobe 3 cases (37.5%). Abnormal sequence: 2 cases (25.0%) with low signal on T1WI, 6 cases (75.0%) with high signal on T2WI, 8 cases (100%) with high signal on FLAIR, and 3 cases (37.5%) with high signal on DWI. There were 3 cases (37.5%) with enhancement, the specific manifestations were punctate and flocculent enhancement in the lesion area, part of the pia mater and adjacent blood vessels.

Conclusion

Although head MRI imaging can not be used as a specific indicator for the diagnosis of anti-NMDAR encephalitis, the possibility of anti NMDAR encephalitis should be highly vigilant when the lesions appear in the medial temporal lobe and (or) the insular lobe, are flaky or patchy, with blurred borders, high signal intensity on FLAIR and (or) T2WI and partial enhancement.

表1 12例抗N-甲基-D-天冬氨酸受体脑炎患者的临床资料
[1]
秦君, 王婷婷, 冯玉芳. 以情绪低落为主要精神异常表现的抗NMDA脑炎1例[J]. 国际精神病学杂志, 2020, 47(4): 848-850.
[2]
中华医学会神经病学分会. 中国自身免疫性脑炎诊治专家共识[J]. 中华神经科杂志, 2017, 50(2): 91-98.
[3]
Honnorat J, Plazat LO. Autoimmune encephalitis and psychiatric disorders[J]. Rev Neurol (Paris), 2018, 174(4): 228-236.
[4]
Kelley BP, Patel SC, Marin HL, et al. Autoimmune encephalitis: pathophysiology and imaging review of an overlooked diagnosis[J]. AJNR Am J Neuroradiol, 2017, 38(6): 1070-1078.
[5]
Wada N, Tashima K, Motoyasu A, et al. Anesthesia for patient with anti-N-methyl-D-aspartate receptor encephalitis: a case report with a brief review of the literature[J]. Medicine (Baltimore), 2018, 97(50): e13651.
[6]
Linnoila JJ, Binnicker MJ, Majed M, et al. CSF herpesvirus and autoanti body profiles in the evaluation of encephalitis[J]. Neurol Neuroimmunol Neuroinflamm, 2016, 3(4): e245.
[7]
Xu XL, Lu Q, Huang Y, et al. Anti-NMDAR encephalitis: a single-center, longitudinal study in China[J]. Neurol Neuroimmunol Neuroinflamm, 2020, 7(1): e633.
[8]
Mitra AD, Afify A. Ovarian teratoma associated anti-N-methyl-D-aspartate receptor encephalitis: a difficult diagnosis with a favorable prognosis[J]. Autops Case Rep, 2018, 8(2): e2018019.
[9]
Phillios OR, Joshi SH, Narr KL, et al. Superficial white matter damage in anti-NMDA receptor encephalitis[J]. J Neurol Neurosurg Psychiatry, 2018, 89(5): 518-525.
[10]
Bacchi S, Franke K, Wewegama D, et al. Magnetic resonance imaging and positron emission tomography in anti-NMDA receptor encephalitis: a systematic review[J]. J Clin Neurosci, 2018, 52: 54-59.
[11]
边仁杰, 徐永强, 胡文鐘, 等. 自身免疫性脑炎的临床及多模态磁共振影像特征分析[J]. 临床医学研究与实践, 2020, 5(12): 14-17.
[12]
Finke C, Kopp UA, Scheel M, et al. Functional and structural brain changes in anti-N-methyl-D-aspartate receptor encephalitis[J]. Ann Neurol, 2013, 74(2): 284-296.
[13]
孙颖志, 张杰, 冯秀龙, 等. 不同亚型自身免疫性脑炎临床及MRI影像特征分析[J]. 延安大学学报(医学科学版), 2020, 18(4): 68-73.
[14]
Bigi S, Hladio M, Twilt M, et al. The growing spectrum of antibody-associated inflammatory brain diseases in children[J]. Neurol Neuroimmunol Neuroinflamm, 2015, 2(3): e92.
[15]
Iizuka T, Kaneko J, Tominaga N, et al. Association of progressive cerebellar atrophy with long-term outcome in patients with anti-N-methyl-d-aspartate receptor encephalitis[J]. JAMA Neurol, 2016, 73 (6): 706-713.
[16]
Hacohen Y, Wright S, Waters P, et al. Paediatric autoimmune encephalopathies: clinical features, laboratory investigations and outcomes in patients with or without antibodies to known central nervous system autoantigens[J]. J Neurol Neurosurg Psychiatry, 2013, 84(7): 748-755.
[17]
Kamble N, Netravathi M, Saini J, et al. Clinical and imaging characteristics of 16 patients with autoimmune neuronal synaptic encephalitis[J]. Neurol India, 2015, 63(5): 687-696.
[18]
胡晓华, 朱庆强, 王军, 等. 磁共振3D-ASL灌注成像鉴别急性脑梗死和脑炎的应用价值[J]. 中西医结合心脑血管病杂志, 2020, 18(24): 4246-4249.
[19]
Irani SR, Stagg CJ, Schott JM, et al. Faciobrachial dystonic seizures: the influence of immunotherapy on seizure control and prevention of cognitive impairment in a broadening phenotype[J]. Brain, 2013, 136(10): 3151-3162.
[20]
Hoftberger R, Titulaer MJ, Sabater L, et al. Encephalitis and GABAB receptor antibodies: novel findings in a new case series of 20 patients[J]. Neurology, 2013, 81(17): 1500-1506.
[1] 丁建民, 秦正义, 张翔, 周燕, 周洪雨, 王彦冬, 经翔. 超声造影与普美显磁共振成像对具有高危因素的≤3 cm肝结节进行LI-RADS分类诊断的前瞻性研究[J]. 中华医学超声杂志(电子版), 2023, 20(09): 930-938.
[2] 张莲莲, 惠品晶, 丁亚芳. 颈部血管超声在粥样硬化斑块易损性评估中的应用价值[J]. 中华医学超声杂志(电子版), 2023, 20(08): 816-821.
[3] 刘冰茹, 刘皓希, 陈莹, 赖世伟, 陈蓉. 疑似乳腺癌的韧带样纤维瘤病一例[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 314-317.
[4] 叶艳娜, 叶瑞婷, 陈艳玲, 彭雯, 刘乐, 肖文秋, 黄辉, 李明深, 钟慕仪, 叶娴. 基于影像学表现和临床病理特征预测良性与交界性乳腺叶状肿瘤复发的列线图模型[J]. 中华乳腺病杂志(电子版), 2023, 17(04): 229-237.
[5] 方心俞, 黄昌瑜, 胡洪新, 林溢铭, 陈旸, 张楠心, 张文明. 膝关节软骨下不全骨折的治疗选择与疗效分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 583-587.
[6] 董晓燕, 赵琪, 唐军, 张莉, 杨晓燕, 李姣. 奥密克戎变异株感染所致新型冠状病毒感染疾病新生儿的临床特征分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 595-603.
[7] 张雯, 张彦春, 刘凯波, 徐宏燕. 北京市胎儿先天性脑积水的产前MRI诊断及围产期转归[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 345-349.
[8] 蒙姣姣, 胡刚, 欧阳涣堃. 肺癌术前淋巴结转移及MWA手术效果预测分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 547-549.
[9] 韩宇, 张武, 李安琪, 陈文颖, 谢斯栋. MRI肝脏影像报告和数据系统对非肝硬化乙肝患者肝细胞癌的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 669-673.
[10] 雷漫诗, 邓锶锶, 汪昕蓉, 黄锦彬, 向青, 熊安妮, 孟占鳌. 人工智能辅助压缩感知技术在上腹部T2WI压脂序列中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 551-556.
[11] 钟广俊, 刘春华, 朱万森, 徐晓雷, 王兆军. MRI联合不同扫描序列在胃癌术前分期诊断及化疗效果和预后的评估[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 378-382.
[12] 吴钰娴, 冯亚园, 霍雷, 贾宁阳, 张娟. 原发性肝脏淋巴瘤的影像学诊断价值研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 349-353.
[13] 冯海涛, 徐涛, 刘文阳, 孙晨, 曹尚超. 三维动脉自旋标记联合动态对比增强MRI对脑胶质瘤术后复发及放射性脑坏死诊断的研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 262-265.
[14] 王志文, 郑雪梅, 张庆坤, 王海江. 自发性低颅压综合征75例临床分析[J]. 中华临床医师杂志(电子版), 2023, 17(04): 398-401.
[15] 赵暾, 徐霁华, 何有娣, 鲁明. 误诊为脑梗死且险些溶栓的急性自发微量脑出血一例[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 369-372.
阅读次数
全文


摘要