| 摘要: |
| 目的 探讨表现为急性脑梗死的特鲁索综合征（TS）的临床及MRI特征，以提高对该病诊断的准确性。方法 收集经临床证实TS伴急性多发性脑梗死（AMBI）患者53例，TS不伴AMBI患者52例，对患者头颅MRI和原发肿瘤影像表现及临床资料进行回顾性分析，比较两组患者的临床特征、MRI特征及血栓类型。结果 两组患者的血栓类型差异有统计学意义（P＝0.001），在性别，年龄，是否患有高血压病、糖尿病、高脂血症、心血管基础疾病，预防用药，凝血功能异常及D-二聚体水平方面差异均无统计学意义（均P＞0.05）。105例TS患者的原发肿瘤类型以腺癌居多。53例TS伴AMBI患者的头颅MRI显示急性及亚急性梗死灶分布区域为双侧前循环的有16例、双侧前循环＋双侧后循环17例、双侧前循环＋单侧后循环4例、单侧前循环16例；增强扫描23例，其中11例患者的部分梗死灶出现强化，12例未见明显强化；28例患者脑动脉未见有意义的狭窄，4例脑动脉可见狭窄闭塞，但其病灶不符合脑血管分布。在可视血栓患者中24例存在动脉血栓（10例颈动脉血栓、3例下肢动脉血栓、5例大脑动脉环血栓、1例肺动脉血栓、1例肾动脉血栓、4例锁骨下动脉血栓），3例静脉血栓（下肢深静脉血栓）；D-二聚体水平均有不同程度的增高。结论 累及双侧大脑及小脑皮质、皮质下区和半卵圆中心的多发点片状、斑片状急性前后循环脑梗死且病灶不符合脑血管分布是恶性肿瘤合并TS的头颅MRI特征表现。恶性肿瘤以腺癌为主，结合D-二聚体指标，可提高诊断的准确性。 |
| 关键词: 特鲁索综合征 急性脑梗死 恶性肿瘤 D-二聚体 磁共振成像 |
| DOI：10.16781/j.CN31-2187/R.20230258 |
| 投稿时间：2023-05-08修订日期：2024-08-26 |
| 基金项目:江西省教育厅科技计划项目（GJJ200189）. |
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| Clinical and magnetic resonance imaging features of Trousseau’s syndrome with acute cerebral infarction |
| XIONG Ruifang,LI Chengyi,ZHU Hanting,TANG Xiaoping* |
(Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the clinical and magnetic resonance imaging (MRI) features of Trousseau’s syndrome (TS) with acute cerebral infarction, so as to improve the accuracy of diagnosis of this disease. Methods Fifty-three cases of TS with clinically confirmed acute multiple brain infarction (AMBI) and 52 cases of TS without AMBI were enrolled, and the head MRI, primary tumor imaging and clinical data of the patients were retrospectively analyzed. The clinical and MRI features and thrombus types of the 2 groups were compared. Results There were significant differences in the types of thrombus between the 2 groups (P＝0.001), while there were no significant differences in gender, age, whether they had hypertension, diabetes mellitus, hyperlipidemia, basic cardiovascular diseases or not, preventive medication use, abnormal coagulation function, or D-dimer level (all P＞0.05). The primary tumor type of 105 TS patients was mainly adenocarcinoma. MRI of the head of 53 TS with AMBI patients showed that the distribution area of acute and subacute infarct foci was bilateral anterior circulation in 16 cases, bilateral anterior circulation＋bilateral posterior circulation in 17 cases, bilateral anterior circulation＋unilateral posterior circulation in 4 cases, and unilateral anterior circulation in 16 cases. Enhancement scans were performed in 23 cases, of which 11 cases showed some infarct foci appeared enhanced and 12 cases did not show significant enhancement. Twenty-eight cases did not show meaningful stenosis of the cerebral arteries, 4 cases showed stenosis occlusion of the cerebral arteries, and all lesions did not conform to cerebrovascular distribution. Twenty-four cases of arterial thrombosis (10 cases of carotid artery thrombosis, 3 cases of lower-extremity arterial thrombosis, 5 cases of cerebral arterial ring thrombosis, 1 cases of pulmonary artery thrombosis, 1 case of renal artery thrombosis, and 4 cases of subclavian artery thrombosis) and 3 cases of venous thrombosis (deep vein thrombosis of the lower extremities) were found among the patients with visualized thrombosis. The D-dimer level was increased in different degrees. Conclusion Multiple speckled and patchy acute anterior and posterior cerebral infarcts involving bilateral cerebral and cerebellar cortex, subcortical areas and hemi-oval centers with lesions not conforming to cerebrovascular distribution are the characteristic manifestations of MRI of the head in the combination of malignant tumors with TS. Adenocarcinoma is the main malignant tumor, and the combination of D-dimer index can improve the accuracy of diagnosis. |
| Key words: Trousseau’s syndrome acute cerebral infarct malignant neoplasms D-dimer magnetic resonance imaging |
