文献速读（009）：尿毒症脑病的MR表现及临床联系 / 开普饭

D.M. Kim, I.H. Lee and C.J. Song

American Journal of Neuroradiology September 2016, 37 (9) 1604-1609; DOI: https://doi.org/10.3174/ajnr.A4776

Abstract

BACKGROUND AND PURPOSE: Uremic encephalopathy is a metabolic disorder in patients with renal failure. The purpose of this study was to describe the MR imaging findings of uremic encephalopathy.

MATERIALS AND METHODS: This study retrospectively reviewed MR imaging findings in 10 patients with clinically proved uremic encephalopathy between May 2005 and December 2014. Parameters evaluated were lesion location and appearance; MR signal intensity of the lesions on T1WI, T2WI, and T2 fluid-attenuated inversion recovery images; the presence or absence of restricted diffusion on diffusion-weighted images and apparent diffusion coefficient maps; and the reversibility of documented signal-intensity abnormalities on follow-up MR imaging.

RESULTS: MR imaging abnormalities accompanying marked elevation of serum creatinine (range, 4.3–11.7 mg/dL) were evident in the 10 patients. Nine patients had a history of chronic renal failure with expansile bilateral basal ganglia lesions, and 1 patient with acute renal failure had reversible largely cortical lesions. Two of 6 patients with available arterial blood gas results had metabolic acidosis. All basal ganglia lesions showed expansile high signal intensity (lentiform fork sign) on T2WI. Varied levels of restricted diffusion and a range of signal intensities on DWI were evident and were not correlated with serum Cr levels. All cortical lesions demonstrated high signal intensity on T2WI. Four patients with follow-up MR imaging after hemodialysis showed complete resolution of all lesions.

CONCLUSIONS: The lentiform fork sign is reliable in the early diagnosis of uremic encephalopathy, regardless of the presence of metabolic acidosis. Cytotoxic edema and/or vasogenic edema on DWI/ADC maps may be associated with uremic encephalopathy.

Fig 1.

A 52-year-old man (patient 4) presented with seizure-like activity. A T2-weighted image (A) and diagrammatic illustration (B) show the lentiform fork sign. A bright hyperintense rim delineates the lateral (external capsule, long arrow) and medial boundaries (external medullary lamina [short arrow] and internal medullary laminae [thin arrow]) of both putamina. The globus pallidus is divided into 2 parts by the medial medullary laminae, which can be seen in pathologic conditions on MR images. A FLAIR image (C) shows multifocal relatively symmetric, gyriform high SI (arrows) in the cortex of bilateral frontal, parieto-occipital lobes and bilateral basal ganglia.

Fig 2.

A 67-year-old man (patient 5) presented with unsteadiness. DWI (A) and an ADC map (B) show diffuse mildly increased SI (long arrows) in the whole bilateral basal ganglia lesion on DWI with focal restricted diffusion (short arrow), corresponding to cytotoxic edema in the right globus pallidus.

Fig 3.

A 70-year-old man (patient 6) presented with involuntary movement. DWI (A) and an ADC map (B) show normal SI (long arrows) in the bilateral basal ganglia on DWI with restricted diffusion (short arrows) in the bilateral globus pallidus and left putamen, compatible with areas of cytotoxic edema in the lesions.

Fig 4.

A 56-year-old man (patient 3) presented with dysarthria. Initial T2WI (A) shows the lentiform fork sign in the bilateral basal ganglia. Six months later, follow-up T2WI (B) shows complete resolution of the lesions.

FROM：http://www.ajnr.org/content/37/9/1604

豆状核叉状征一例

摘要：

豆状核叉状征(lentiform fork sign),是由Kumar和Goyal[1]于2010年提出的一种特征性神经影像学改变,为双侧豆状核基本对称的异常信号,临床多见于亚洲人群,特别是糖尿病终末期肾病患者.目前国外仅报道30余例[2],我国尚少有类似报道.近期我院肾内科1例患者符合此综合征表现,现报道如下.

作者：万里姝 ^[1] 李国祝 ^[2] 姜楠 ^[2]

作者单位：118000,辽宁省丹东市第一医院神经内科 ^[1] 118000,辽宁省丹东市第一医院肾内科 ^[2]

期刊：《中华神经科杂志》2016年49卷5期 398-399页

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[3]Lee EJ,Park JH,Ihn YK,etc.Acute bilateral basal ganglia lesions in diabetic uraemia: diffusion-weighted MRI.[J].2007,12(12).
[4]Dicuonzo F,Di Fede R,Salvati A,etc.Acute extrapyramidal disorder with bilateral reversible basal ganglia lesions in a diabetic uremic patient: diffusion-weighted imaging and spectroscopy findings.[J].2010,1/2(1/2).
[5]Yoon CH,Seok JI,Lee DK.Bilateral basal ganglia and unilateral cortical involvement in a diabetic uremic patient.[J].2009,5(5).
[6]Jurynczyk M,Rozniecki J,Zaleski K,etc.Hypoglycemia as a trigger for the syndrome of acute bilateral basal ganglia lesions in uremia.[J].2010,1/2(1/2).

文献速读（009）：尿毒症脑病的MR表现及临床联系

Abstract

豆状核叉状征一例

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