磁共振成像在多系统萎缩诊断与鉴别诊断中的应用价值

目的:探讨磁共振成像(MRI)在诊断多系统萎缩(MSA)及鉴别MSA与帕金森病(PD)中的应用价值。方法:对26例MSA患者(MSA组)、20例PD患者(PD组)及18例健康对照者(对照组)进行MRI检查,观察脑实质萎缩、脑桥十字征、壳核外侧缘裂隙征、MCP高信号、壳核低信号,并测量所有受试者的MCP宽度。结果:所有MSA患者均可见不同程度的小脑、脑桥、延髓、壳核萎缩,四脑室及桥延池扩大,其中15例(57.7%)可见脑桥十字征,6例(23.1%)可见T2像轴位MCP高信号,8例(30.8%)可见裂隙征,4例(15.4%)可见T2像壳核低信号。MSA组MCP宽度(6.4±1.4)mm明显小于PD组(9.2±1.1)mm与对照组(9.4±0.8)mm(P均<0.01),PD组MCP宽度与对照组差异无统计学意义。15例MRI有脑桥十字征的MSA患者MCP宽度平均为(5.3±1.0)mm,11例MRI无脑桥十字征的MSA患者MCP宽度平均为(7.2±1.6)mm,两者比较差异有统计学意义(P<0.05)。结论:MRI有助于MSA的诊断;MRI测定MCP宽度可作为鉴别MSA与PD的一个指标。

Application of Magnetic Resonance Imaging in Diagnosis of Multiple System Atrophy

Objective：To explore the application of magnetic resonance imaging （MRI） in diagnosing multiple system atrophy （MSA） and distinguishing MSA from PD. Methods： Twenty-six consecutive patients with MSA, 20 consecutive patients with PD and 18 healthy control subjects were examined with MR/. The imaging changes focused on the presence or absence of brain atrophy including the cerebellum, pons, medulla oblongata and putamen atrophy, cruciform hyperintensity of the pons, slit-like hyperintensity in the posterolateral margin of the putamen, hyperintensity of the MCP, and hypointensity of the putamen. Measurements of the MCP width were performed in all subjects. Results： All patients with MSA had different severity of atrophy in the cerebellum, pons, medulla oblongata and/or putamen. Cruciform hyperintensity of the pons was found in 15 cases with MSA; hyperintensity of the MCP in 6 cases with MSA; slit-like hyperintensity in the posterolateral margin of the putamen in 8 cases with MSA; and hypointensity of the putamen in 4 cases with MSA respectively. The MCP width was significantly smaller in MSA group （6.4±1.4）mm than that in PD group（9.2±1.1） mm or control group （9.4±0.8）mm. The average MCP width in 15 MSA patients with cruciform hyperintensity was significantly lower （5.3±1.0）mm than that in 11 MSA patients without cruciform hyperintensity （7.2±1.6 mm） （P〈0.05）. Conclu- sion： The MR imaging is useful for diagnosing MSA. Measurement of MCP width on MR images is helpful for distinguishing patients with MSA from those with PD.