脊髓多发性硬化的MRI诊断及临床分析

目的分析脊髓多发性硬化的临床特点、MRI征象及其诊断价值。方法收集经MRI检查诊断,并经临床治疗证实为脊髓多发性硬化25例;其中男8例,女17例,年龄为21岁～64岁(平均年龄32岁),全部病例行MRI检查。结果脊髓多发性硬化主要临床表现为:四肢麻木、无力伴活动不良,颈部疼痛、感觉异常,视神经损害,共济失调,尿便功能障碍。病灶分布颈段脊髓最多(13/25),颈胸髓同时受累(9/25),胸髓受累(2/25),全身脊髓受累(1/25)。MRI特征性表现为:大多数病变矢状位长度小于4个椎体,长度大于宽度;急性期病变局部脊髓肿胀,病灶呈斑片状、条带状;T1WI呈等或界限模糊的稍低信号,T2WI为长短不一的条状高信号。轴位像病灶位于脊髓侧方和后方,一般小于脊髓截面1/2。静脉注射Gd-DTPA后,活动期病灶呈条状、片状强化,但强化区范围明显小于T2高信号灶范围。经激素正规治疗后病灶脊髓恢复正常,强化程度减弱或无明显强化。结论脊髓多发性硬化的MRI表现具有一定特征性。MRI检查多方位、多序列成像,对其诊断、治疗及随访等有重要作用,因此脊髓多发性硬化的检查应首选MRI。

MRI Diagnosis of Multiple Sclerosis in Spinal Cord and its clinical analysis

Objective The purposes of this study were to analyze clinical characteristic and its signs on images of magnetic resonance imaging and MRI diagnosis values of Multiple Sclerosis in Spinal Cord.MethodsThere were 25 cases patients with spinal cord multiple sclerosis.The diagnosis of all patients had confirmed by clinical treatment and MRI diagnosis.In these patients,the male were 8 cases and the female were 17 cases.The age of these patients ranged from 21 to 64 years old,mean 32 years old.All patients had checked by MRI.Results The main clinical manifestations of spinal cord multiple sclerosis were limbs anesthesia,powerless and bad action,cervical part odynia,cacesthesia,cranial nerve lesion,ataxia,urine and sedes functional disturbance and so on.The lesion mainly developed in cervical cord.Cervical spinal cord was involved in 13 cases;cervical and thoracic spinal cord simultaneously in 9 cases;thoracic spinal cord in 2 cases and whole spinal cord in 1 case.On MRI,spinal MS showed some characteristics,The length of the lesion usually covered shorter than four vertebra bodies,The length was longer than the width.The diseasod cord was swollen in acute stage.The lesions were manifested as patches in shape and long ribbon shape with low or iso-signal intensity on TlWI and high-signal intensity on T2WI.The lesions usually located lateral or posterior surface in the axial image,and it was smaller than half axial area.The lesions in active stage were enhanced by Gd-DTPA,showing patchy or lamella-shape enhancement.The enhanced regions smaller than which were high-signal intensity on T2WI,The lesions anastated after had been treated with excitatory autacoid,The enhancement was lower or without enhancement on enhanced MRI scan.Conclusion MS of spinal cord has characteristic features on MRI and MR is the most important and sensitive method for diagnosing spinal cord MS.It is import to diagnose,treat and follow-up visit for MRI,multi-azimuths and multisequencing imaging.