脊髓多发硬化与特发急性横贯性脊髓炎MRI鉴别诊断

目的：探讨脊髓多发硬化（ＭＳ）和特发急性横贯性脊髓炎（ＩＡＴＭ）的ＭＲＩ特点及鉴别诊断的可能性。方法：对比分析了１６例ＭＳ和７例ＩＡＴＭ的临床表现和ＭＲＩ特点。ＭＲ基本扫描序列为ＳＥ序列Ｔ１ＷＩ、Ｔ２ＷＩ矢状位和Ｔ２ＷＩ轴位，７例行Ｇｄ－ＤＴ－ＰＡ强化。结果：１６例ＭＳ脑脊液寡克隆带阳性８例，７例ＩＡＴＭ病前发烧３例，余临床表现相似。两者ＭＲ信号特点相似，均为Ｔ１ＷＩ稍低或等信号，Ｔ２ＷＩ高信号，但ＭＳ表现病灶多发（９３％）、长度不超过２个椎体（８８％），主要分布在白质区（９３％）的特点，而ＩＡＴＭ以病灶单发（５７％）、长度大于２个椎体（７１％）、全脊髓分布或灰质分布为主（７１％）。结论：ＭＲＩ对脊髓ＭＳ和ＩＡＴＭ的诊断和鉴别诊断有重要作用。综合分析ＭＲ表现、临床特点、脑脊液检查等有助于正确诊断

Multiple Sclerosis of the Spinal Cord and Idiopathic Acute Transverse Myelitis:MR imaging Differential Diagnosis

Objective:To analyse the MR findings and the possibility of differential diagnosis of multiple sclerosis of the spinal cord(MS)and idiopathic acute transverse myelitis(IATM).Methods:Clinical and MRI findings of 16 patients with MS and 7 patients with IATM were retrospectively reviewed.Sagittal T 1WI,T 2WI and axial T 2WI were performed in all cases on a 0.5T unit.Among them 7 cases underwent gagolinum-enhanced MRI.Results:The oligoclonal gammopathy zone of cerebrospinal fluid is positive in eight of 16 patients with MS.Three patients with IATM had fever before MR examination.The other clinical pictures were similar in both of them.All of the patients were seen similar MR signal intensity,that was hypor iso-intensity on T 1WI,hyperintensity on T 2WI,but MS was different from IATM in number,length,and distribution of the lesions.In the majority of MS,the lesions were multiple(98%),mainly in white matter(93%),and less than two vertebral bodies in length(88%).In IATM,the lesions were solitary(57%),in the gray and white matter(71%),and more than two bodies in length(71%).Conclusion:MRI plays an important role in diagnosis and differential diagnosis of MS and IATM of the spinal cord.We consider that synthetical analysis of the clinical,CSF,examination and MR imaging is helpful for correcting diagnosis.