脊髓多发性硬化的MRI诊断与鉴别诊断

目的　提高对脊髓多发性硬化MRI特征的认识。方法　对 15例脊髓多发性硬化患者行颈部MRI检查。对病变的位置、长度、横断面上病变大小及病变的强化进行评价 ,并与脊髓内肿瘤、脊髓型颈椎病、急性横贯性脊髓炎的MRI表现进行比较。结果　 15例脊髓多发性硬化主要发生在颈段脊髓 ,病变一般少于 5个椎体长度 ,MRI特点为矢状位脊髓局限性梭形增粗 ,边缘光滑。T1WI呈等或界限模糊的稍低信号 ,T2 WI呈长短不一的条形高信号。轴位像病灶位于脊髓侧方和后方 ,一般小于脊髓截面 1/2。活动期病灶呈条、片状强化 ,但强化区范围明显小于T2 高信号灶范围。反复发作病例多发病灶强化多样性 ,也可不强化。结论　脊髓多发性硬化有其特征性MRI表现 ,能为临床诊断提供可靠的依据

MRI Diagnosis and Differential Diagnosis of Multiple Sclerosis in the Spinal Cord

Objective To increase the ability to recognize the characteristic MRI features of multiple sclerosis (MS) in the spinal cord. Methods Fifteen patients with MS underwent MR examination of the cervical spine. The MS plaques were evaluated for lesion location, length,size on cross-section and lesion enhancement. MRI features of intraspinal tumor of spinal cord, cervical spondylopathy of myeloid form and transverse myelitis were analyzed and compared. Results The lesion mainly developed in cervical cord in the 15 patients. The lesions were less than five vertebra body in length. MRI features showed that involved cord segment was mild swollen with smooth periphery in sagittal section;the plaques showed iso-mild hypointense on T 1WI and hyperintense on T 2WI; the plaques were located peripherally and occupied less than 50%of the cross-sectional area of the cord; the lesions in active stage were enhanced by Gd-DTPA or no enhancement, the enhanced size of plaque was smaller than the extent showing hyperintense on T 2WI. The case of several onset showed various enhancement. Conclusion MS of spinal cord has characteristic feature on MRI, this can provide reliable proof for clinical diagnosis.