多发性硬化脊髓受累临床与MRI对照研究

目的分析多发性硬化脊髓受累患者临床表现及MRI影像学特点,并探讨其临床诊断意义。方法回顾分析2006年1月-2009年12月住院治疗的46例多发性硬化脊髓受累患者的临床资料及影像学表现。结果起病形式以急性（58．70％,27／46）或亚急性（34．78％,16／46）为主,临床主要表现为肢体瘫痪（95．65％,44／46）、感觉障碍（84．78％,39／46）和尿潴留（67．39％,31／46）。MRI受累部位以颈髓最常见（45．65％,21／46）,其次为胸髓（28．26％,13／46）,呈脊髓内单一或散在多发长T。、长T：斑片状异常信号影,病灶长度一般不超过2个椎体节段（84．78％,39／46）,个别患者（15．22％,7／46）病灶长度超过2个椎体节段;增强扫描可有不同程度强化（78．26％,36／46）。结论多发性硬化脊髓受累患者临床表现复杂多样,MRI脊髓受累可呈现单一或散在多发病灶,病灶长度较少超过2个椎体节段,但病灶节段延长不能排除多发性硬化。MRI是诊断多发性硬化脊髓受累最敏感和最特异的影像学检查方法。     

脊髓多发性硬化的MRI表现与临床对照分析

目的 探讨脊髓多发性硬化(multiple sclerosis，MS)的MRI表现及其与临床的相关性。方法 分析13例脊髓MS患者，对病变的部位、范围及病变处脊髓的形态、MR信号及病变的强化程度进行分析评价并与临床症状进行对照。结果 13例脊髓MS主要发生在颈髓，急性期局部脊髓肿胀，T1加权像病变呈等信号或边缘模糊的稍低信号。T2加权像呈高信号。活动期病灶呈斑片状、环状或弓形强化。反复发作病例、多发病灶其强化多样性，临床症状多变性。结论 脊髓MS有其特征性MRI表现，其与临床有较强的相关性，能为临床诊断和治疗提供可靠的依据。     

脊髓多发性硬化的MRI表现与临床对照分析

目的 探讨脊髓多发性硬化(multiple sclerosis,MS)的MRI表现及其与临床的相关性。方法 分析13例脊髓MS患者,对病变的部位、范围及病变处脊髓的形态、MR信号及病变的强化程度进行分析评价并与临床症状进行对照。结果 13例脊髓MS主要发生在颈髓,急性期局部脊髓肿胀,T1加权像病变呈等信号或边缘模糊的稍低信号。T2加权像呈高信号。活动期病灶呈斑片状、环状或弓形强化。反复发作病例、多发病灶其强化多样性,临床症状多变性。结论 脊髓MS有其特征性MRI表现,其与临床有较强的相关性,能为临床诊断和治疗提供可靠的依据。     

多发性硬化MRI研究新进展

多发性硬化（multiple sclerosis，MS）是中枢神经系统最常见的脱髓鞘疾病，其诊断一直强调病史和体格检查的重要性。但是随着MRI技术的发展与应用．这一情况发生了改变。2000年7月制订的McDonald诊断标准第一次将MRj用于MS的诊断，并明确地说明了MS时间和空间上多发性的MRI证据．从而有利于对患者尤其是表现为临床孤立综合征（clinically isolated syndrome，CIS）的患者进行早期诊断。超微型超顺磁性氧化铁颗粒（ultrasmall superparamagnetic iron oxides，USPIOs）对比剂及MRI新技术在显示MS特异性征象、病变与病理变化及临床功能障碍之间的相关性、定量研究、早期诊断及疗效监测等方面提供了更多特异性信息。本文对此进行综述。     

脊髓型多发性硬化临床诊断分析

目的 总结分析脊髓型多发性硬化(MS)的临床特点和MRI表现.方法 回顾性分析21例脊髓型MS的临床特点和MRI表现,所有患者行脊髓和颅脑MRI检查.结果 脊髓型MS除有脊髓病变的临床表现外,临床症状和体征的多样性是其特点,如感觉障碍、肢体无力、视力障碍等;脊髓内病灶的MRI特点是不规则斑片状和条带状异常信号,位于脊髓两侧和后部,在T:WI像上为高或稍高信号,在T1WI上为等信号或稍低信号;80.9%(17/21)脊髓型MS合并脑内病灶.结论 脊髓型MS临床表现呈多样性,MRI可以准确显示脊髓内病灶,颅脑MRI检查有助于脊髓型MS的诊断.     

颅脑多发性硬化的临床及MRI诊断

目的 探讨多发性硬化(MS)的临床及MRJ特征,提高对多发性硬化的认识及诊断水平.方法 对20例颅脑MS患者临床资料、病灶部位、形态、MR信号及强化特点、胼胝体改变进行回顾性分析评价.结果 MS以青、中年女性稍多见,急性、亚急性起病,多以视觉障碍或肢体感觉、运动障碍为首发症状.视觉诱发电位大多数异常.MRJ检查18例发现病灶,敏感性90%(18/20).病灶以双侧侧脑室旁、额叶皮层及皮层下、半卵圆中心多发.病灶大、小不等,多数为圆形、卵圆形."直角脱髓鞘征"及"白质变脏征"是两个较为典型的征象.T1WI上表现为等、低信号,T2WI及Flair序列上表现为高信号,Flair序列显示病灶更清晰.增强扫描病灶可呈结节状强化、环状强化、弧形强化或无强化.结论 MS的临床及MRI表现具有一定特征.MRI有助于脑部MS的诊断及鉴别诊断,是诊断MS最敏感的成像方法.     

多发性硬化临床与磁共振研究

目的：探讨多发性硬化（MS）的MRI表坎特点及与临床表现的相关性,以及MRI对MS的诊断价值。方法：对44例临床确诊的MS进行头部和／或脊髓MRI横断面,矢状面和冠状面扫描。结果：MS临床表现主要为视力减退,感觉障碍．肢体瘫痪,共济失调等。MRI表现为异常信号呈T1和／或等T1及长T2改变且分布广泛。病变分布以大脑皮质下白质、脑室周围、丘脑、胼胝体、脑干、小脑、颈胸段脊髓等明显、脑室旁椭圆形病灶与矢状位垂直及发现胼胝体脱髓鞘病灶为本病较具特征性的改变。MRI尚可发现无症状病变。结论：MRI不仅有助于MS诊断．尚能动态观察MS病情进展及评估疗效。     

MRI在多发性硬化中的应用

近年来波谱成像、磁化传递成像、弥散张量成像、双反转回波成像等磁共振新技术在多发性硬化的早期诊断、病情评估、治疗监测、预后判断及研究中发挥着越来越大的作用。现就磁共振在多发性硬化中的应用做一综述。     

多发性硬化三例标本MRI长T2信号与病理对照研究

采用磁共振成像（ＭＲＩ）与病理对照方法探讨多发性硬化（ＭＳ）ＭＲＩ异常长Ｔ２信号与病理改变的关系。对３例经１０％福尔马林固定的全脑标本（其中１例含脊髓）行自旋回波（ＳＥ）序列扫描，对照ＭＲＩ图像所示的长Ｔ２信号行标本大体及镜下观察。３例ＭＳ均显示有长Ｔ２信号，其病理基础除ＭＳ斑块外还可见坏死软化灶及空洞形成。斑块状长Ｔ２信号具有特征性的ＭＲＩ表现：直角脱髓鞘征，见于病程长者（例１）。坏死软化灶及空洞形成引起的非斑块状长Ｔ２信号形态分布不一，以病程短、起病急者为著（例２、３），后者脊髓受累程度亦严重。ＭＲＩ是诊断ＭＳ最有价值的影像学检查方法。ＭＳ长Ｔ２信号的病理基础除典型硬化斑外还有坏死软化灶及空洞形成。当临床拟诊为ＭＳ，而ＭＲＩ仅显示非斑块状长Ｔ２信号时，应警惕为急性发病的ＭＳ。     

多发性硬化PET代谢显像与MRI和病理对照研究

目的 比较磁共振成像(MRI)检查和正电子发射断层显像(PET)及病理对判定脑内多发性硬化(MS)，尤其是脱髓鞘假瘤及疾病分期的价值。方法 经临床明确诊断的MS2例．均经过MRI扫描，T1、T2加权，行PET显像，将两者进行比较，其中1例病灶做病理检查。结果 2例MRI扫描T1WI表现为低信号．T2WI可见明确高信号，例2呈团块状。PET显像：例1右侧顶叶、左侧小脑半球等处可见形态欠规则的稍高代谢灶；例2左侧顶叶、颞叶及枕叶皮层及皮层下显示较大范围代谢降低区。病理学检查证实病灶处有大量泡沫样细胞(CD68^ )及增生的胶质细胞，病灶区血管周围T淋巴细胞浸润呈套袖状，髓鞘染色显示髓鞘脱失。结论 使用PET技术可辅助判定脑内白质区病灶是急性期还是非急性期，并可协助鉴别脱髓鞘假瘤与颅内肿瘤，同时能为MS患者脑功能异常与病蛮的范围的关系提供良好依据。     

A spinal cord MRI study of benign and secondary progressive multiple sclerosis

This study was performed to achieve a better definition of the nature of the disability in multiple sclerosis (MS). Axial spinal cord magnetic resonance imaging (MRI) at C5 was obtained in 15 patients with benign MS, 17 patients with secondary progressive MS and 10 healthy controls. Patients with secondary progressive MS had smaller spinal cord cross-sectional area (P = 0.01) and transverse diameter (P = 0.006) than patients with benign MS. The degree of disability was inversely correlated with both the cross-sectional area (r = –0.6,P = 0.0018) and transverse diameter (r = –0.5,P = 0.0032) of the cord. Spinal cord atrophy was found in 7 (41%) patients with secondary progressive MS and in 2 (13%) with benign MS. These findings suggest that destructive pathology within MS lesions might play a relevant role in the development of disability in MS.     

Magnetic resonance imaging in patients with multiple sclerosis and spinal cord involvement: 28 cases

In patients with clinically isolated spinal disease, magnetic resonance imaging (MRI) provides a non-invasive method of detecting surgically treatable causes and is also useful in detecting asymptomatic brain lesions where the cord syndrome is due to multiple sclerosis (MS). We report the findings of spinal and brain MRI in 28 patients with spinal cord disorder due to MS. It was possible to detect intrinsic plaques reliably in the majority of patients (60.7%) with clinical findings of spinal cord MS. The results of MRI are compared with the clinical status and with cerebrospinal fluid findings and evoked potentials.     

脊髓型多发性硬化的MRI表现

目的总结分析脊髓型多发性硬化的MRI表现。方法搜集经临床证实的脊髓型多发性硬化11例,均行MRI检查,对其临床及MRI资料进行回顾性分析。结果脊髓型多发性硬化的特征性MRI表现为,11例患者的病灶以颈髓多见,病变脊髓在T1WI像为低或等信号,T2WI像为高信号,病灶位于脊髓两侧和后部,病灶活动期呈斑片状或边缘强化,应用糖皮质激素试验性治疗对脊髓出现的可疑脱髓鞘病灶者有一定的帮助。结论脊髓型多发性硬化有其特征性MRI表现,MRI有助于脊髓型多发性硬化的诊断,是目前诊断脊髓型多发性硬化最敏感的影像学方法 。     

多发性硬化患者颈髓扩散张量成像研究

目的 通过扩散张量成像研究多发性硬化患者常规MRI表现正常脊髓(NASC)的改变,并探讨其临床应用价值.方法 采用平面回波成像技术对13 例多发性硬化患者和13 例健康志愿者施行颈髓扩散张量成像检查,分别测量第2 ~ 5 颈椎(C2 ~ 5)水平前索、后索、侧索及灰质兴趣区的部分各向异性(FA)值及平均扩散率(MD)值,比较两组之间所存在的差异性;相关分析检验多发性硬化组患者FA值和MD 值与扩展残疾状态量表(EDSS)评分之间的关系.结果 与正常对照组相比,多发性硬化组患者C2 ~ 5 前索、侧索、后索和灰质NASC 的FA 值降低、MD 值升高(均P < 0.05);相关分析显示,FA 值与EDSS 评分呈负相关(r = - 0.328 ~ - 0.207,P = 0.001 ~ 0.035),各兴趣区MD 值与EDSS 评分呈正相关(r =0.234 ~ 0.409,P = 0.000 ~ 0.018).结论 多发性硬化患者常规MRI 表现比正常脊髓的FA 值降低,提示存在隐匿性病变.脊髓扩散张量成像对多发性硬化患者临床评价和疗效判断有一定应用价值.     

Autonomic dysfunction in multiple sclerosis: cervical spinal cord atrophy correlates

Autonomic dysfunction has rarely been studied in patients suffering from multiple sclerosis (MS). Some hypotheses have concerned the pathophysiology, especially with regard to a possible spinal cord origin. However, there have been no previous studies on autonomic dysfunction in MS and spinal cord lesions. This study assessed the frequency of autonomic dysfunction (AD) in MS and the correlation to spinal cord magnetic resonance imaging (MRI) findings. We prospectively studied 75 MS patients (25 with relapsing-remitting forms, 25 with secondary progressive forms and 25 with primary progressive forms). We performed sympathetic skin response, R-R interval variability and orthostatic hypotension testing. Spinal cord MRI was performed to detect demyelinating lesions (sagittal and axial plane) or spinal cord atrophy. Clinical and laboratory evidence of AD was found in 84 % and 56 % of MS patients, respectively. The correlation of the latter with disability was evaluated using the Extended Disability Status Scale. AD was more frequent in primary progressive MS than in the other two forms. AD was correlated with spinal cord cross-sectional area reduction but not with spinal cord hyperintensities. This study confirms that the frequency of AD in MS, especially in primary progressive forms, has until now been underestimated. Furthermore, AD appears to be more closely related to axonal loss, as demonstrated by spinal cord atrophy, than to demyelinating lesions. Received: 20 March 2000, Received in revised form: 13 October 2000, Accepted: 29 October 2000     

Prognostic value of spinal cord MRI in multiple sclerosis patients

Multiple sclerosis [MS] is a common inflammatory, demyelinating and neurodegenerative disease of the central nervous system that affects both the brain and the spinal cord. In clinical practice, spinal cord MRI is performed far less frequently than brain MRI, mainly owing to technical limitations and time constraints. However, improvements of acquisition techniques, combined with a strong diagnosis and prognostic value, suggest an increasing use of spinal cord MRI in the near future. This review summarizes the current data from the literature on the prognostic value of spinal cord MRI in MS patients in the early and later stages of their disease. Both conventional and quantitative MRI techniques are discussed. The prognostic value of spinal cord lesions is clearly established at the onset of disease, underlining the interest of spinal cord conventional MRI at this stage. However, studies are currently lacking to affirm the prognostic role of spinal cord lesions later in the disease, and therefore the added value of regular follow-up with spinal cord MRI in addition to brain MRI. Besides, spinal cord atrophy, as measured by the loss of cervical spinal cord area, is also associated with disability progression, independently of other clinical and MRI factors including spinal cord lesions. Although potentially interesting, this measurement is not currently performed as a routine clinical procedure. Finally, other measures extracted from quantitative MRI have been established as valuable for a better understanding of the physiopathology of MS, but still remain a field of research.     

Long spinal cord lesions in a patient with pathologically proven multiple sclerosis

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. We report the case of a 50-year-old man who presented with progressive gait ataxia. Brain magnetic resonance imaging (MRI) on fluid-attenuated inversion recovery revealed a hyperintense lesion in the right temporal white matter. The spinal cord showed a long hyperintense lesion between the vertebral levels C6 and L1 on T2-weighted MRI. Biopsied tissues from the brain lesion demonstrated features of inflammatory demyelination with preservation of astrocytes, consistent with typical MS. This is the first reported case of pathologically proven MS with longitudinally extensive spinal cord lesions.