视神经脊髓炎患者33例脑部磁共振分析

目的 探讨视神经脊髓炎(neuromyelitis optica,NMO)患者脑部MRI影像学表现.方法 收集满足最新NMO诊断标准且脑部MRI表现不符合多发性硬化诊断标准的患者33例,均行脑部和脊髓MRI检查,分析其MRI影像学特点.结果 33例NMO中,脑部正常表现者5例(15.2%),异常表现28例(84.8%),其中脑内实质有明确病灶22例(66.7%),另6例(18.2%)脑内虽未见明确病灶,但深部脑白质显示了肉眼可视的对称性弥漫性脱髓鞘高信号影.22例明确病灶中,15例病灶数≥2个,7例为单个病灶.幕上近皮质、皮质下和深部脑白质区的点状非特异性病灶最多,少数为非典型的斑片状融合病灶.幕下脑干是易受累的部位(14/33,42.4%),特别是延髓(7/33,21.2%).结论 NMO患者出现脑内异常较为常见,有脑部的异常不能排除NMO的诊断.认识NMO脑内病灶对完善NMO诊断标准有帮助.

Brain magnetic resonance imaging findings in 33 patients with neuromyelitis optica

Objective To investigate the brain magnetic resonance imaging(MRI)findings in 33 patients with neuromyelitis optica(NMO).Methods Patients who fulfilled the latest diagnostic criteria of NMO and whose brain MRI did not satisfied with diagnostic criteria of multiple sclerosis(MS)were enrolled.All the patients underwent brain MRI and spinal cord scannings and subsequent images analysis.Results Thirty-three patients with NMO were included to study.Five out of 33(15.2%)patients did not have brain parenchymal abnormalities,28 out of 33 patients(84.8%)were detected to have brain abnormal findings.Brain parenchymal lesions were well-defined in 22 patients(66.7%),no non-specific or atypical brain parenchymal lesions were found in the supratentorium or infratentorium in the other 6 cases(18.2%).However,brain MRI disclosed macroscopic,symmetrical diffuse FLAIR and T2-visible hyperintensity in deep white matter.Fifteen cases had more than one lesion(≥2 lesions),and the other 7 cases had single lesion.Supratentorial lesions were mostly punctate or small dots in nonspecific hyperintensity in juxtacortical,subcortical and deep white matter regions,a few were atypical patches.In the infratentorium,brainstem was an easily involved region(14/33,42.4%),especially in medulla(7/33,21.2%).Conclusions Brain MRI abnormalities are common in Chinese NMO,and brain lesions do not exclude the diagnosis of NMO.The observations of brain lesions are helpful to improve and revise diagnostic criteria of NMO.