Objective To review the magnetic resonance imaging (MRI) features and explore the histopathological basis of heroin-associated encephalopathy (HE). Methods The data were collected from 34 established HE cases diagnosed with epidemiological evidence, clinical manifestations, MRI findings and laboratory examination. Hispathological sections were obtained in 10 cases. All patients were examined with T1WI, T2WI and FLAIR using 1.5T MRI scanner. Four patients died and autopsy was performed in 2 of them. Eight patients underwent stereotactic cerebral biopsy and the results of pathological examination were compared with the MRI findings. Results All the 34 cases had low signals in T1WI but high signals in T2WI. Extensive involvement of the hemispheres beyond the cerebellar tentorium, brain stem and cerebellum was identified in 85.3% of the cases, and less than 10% had lesions involving only one of these three structures. Most of the lesions involved mainly the white matter, and 91.2% of the cases showed involvement of the bilateral hemispheres. Specific MRI features were found to help in HE diagnosis: lesions compromising the hemispheres beyond the cerebellar tentorium presented with the pattern resembling the Chinese character "eight", a hollow pattern was found in brain stem involvement, and "butterfly wing" pattern in cerebellar involvement. The abnormal signals were caused mainly by demyelination and vacuole formation in the white matter, and these vacuoles resulted in the sponge-like appearance of the white matter containing fluid. Conclusion MRI can provide strong evidence for HE diagnosis and can be informative of the involvement, position and aggravation of the lesions with some characteristic MRI features. In most of the cases, a MRI-based diagnosis can be consistent withhisptopathological diagnosis.%目的 探讨海洛因脑病(heroin-associated encephalopathy,HE)的MRI特点及其病理基础.方法 34例病例中,根据流行病学、临床表现、MRI、实验室检查及其中10例病理检查结果,排除其他疾病而诊断HE.MRI检查用1.5T MRI扫描仪,行T1WI、T2WI、FLAIR检查.4例死亡患者中2例进行尸解,8例行脑立体定向活检.MRI与病理对照分析.结果 34例HE,全部病例T1WI低信号,T2WI高信号.病灶同时累及幕上半球、脑干及小脑占85.3%,三者分别单独受累均＜10%.病灶以累及脑白质为主.脑内两侧同时受累占91.2%.MRI显示的幕上半球"八字征"、脑干的"中空征"、及小脑的"蝶翼征"诊断HE有一定意义.MRI信号改变,主要与HE的脑白质脱髓鞘及大量空泡形成,这些空泡构成海绵状结构,内含液体增多有关.结论 MRI对HE能准确的定位定量诊断,并有一定特征MRI表现.MRI显示HE与病理之间有很好的相关性.
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