MRI对脊髓型多发性硬化临床分期的价值

目的:探讨脊髓型多发性硬化(MS)的MRI表现及其病理基础,评价MRI对MS临床分期价值。方法:脊髓型MS患者43例,按临床特点分为急性期、静止期和缓解复发期。对所有患者行头部和脊柱磁共振检查,分析各期的MRI表现。结果:脊髓型MS的主要MRI表现为髓内长或等T1、长T2信号改变。脊髓型MS各期的MRI特点:①急性期11例,均表现为脊髓轻度~中度肿胀,增强扫描时10例(90.9%)髓内病灶有明显强化,其中9例呈斑片状或边缘环状强化,1例呈结节状强化,范围明显小于T2WI上所见;1例无强化。4例伴脊髓中央管扩张。有8例经治疗后病灶缩小,脊髓肿胀消失。②静止期17例,14例(82.4%)脊髓形态、大小未见异常,髓内病灶均无强化。③缓解复发期15例中,11例(73.3%)伴有脊髓萎缩,增强扫描时5例出现轻度点状或条状强化,病变范围与T2WI所见相似。各期脊髓型MS的病变范围及分布差异无显著性意义(P>0.05)。结论:MRI能反映脊髓型MS各期的病理变化,对脊髓型MS的分期具有重要价值。

The Value of MRI in the Clinical Staging of Spinal Cord Multiple Sclerosis

Objective:To evaluate the MRI manifestations in different clinical stages of spinal cord multiple sclerosis (MS).Methods:43 cases of spinal cord MS which were divided into acute,resting and remitting-relapsing stage according to clinic settings,had brain and spinal cord MRI,and their MRI findings were analyzed retrospectively.Results:The MRI manifestations of spinal cord MS were intra-spinal cord well-defined patches with hypo-/iso-intensity on T_1WI and hyper-intensity on T_2WI.In the acute stage (n=11),the diseased spinal cords were slightly to moderately swollen in all cases,showing patchy or ring-like enhancement (n=9) and nodular enhancement (n=1) after intravenously administration of Gd-DTPA,enhancement of the lesions were obviously smaller than that shown on T_2WI;There was no enhancement in 1 case.4 cases had dilatation of central canal of spinal cord.Reduction of the size of lesion and swollen of spinal cord were shown after steroid therapy (n=8).In the resting stage (n=17),the shape and size of spinal cord were normal in 14 cases(82.4%),with no enhancement of the spinal cord lesion after intravenously administration of Gd-DTPA.In the remitting-relapsing stage,9 cases (73.3%) had spinal cord atrophy,showing dotted or linear enhancement in 5 cases.There were no significant difference in the extent and distribution of lesions in different clinical stages.Conclusion:MRI was helpful in the evaluation of the clinic stage and their pathologic changes of spinal cord MS,and played important role in the clinical application of spinal cord MS staging.