多发性硬化脑内磁共振病灶分布及其特征(附203例2年MRI随访结果)

目的　为了解多发性硬化 ( multiple sclerosis,MS)的病灶特点 ,对确诊的 2 0 3例 MS患者进行系列磁共振 ( magnetic resonance,image,MRI)观察。方法　选择确诊的缓解 -复发型 MS患者 2 0 3例 ,每 6个月检查头颅MRI一次。结果　 ( 1 ) 2 0 3例 MS患者中 ,1 72 ( 84 .7% )例脑 MRI显示脱髓鞘病灶。其中有胼胝体病灶者 90例( 5 2 % ) ,有脑干病灶者 1 0 6例 ( 6 2 % ) ,有小脑病灶者 4 6例 ( 2 8% ) ,有与脑室连接的病灶者 1 5 7例 ( 91 % ) ,有典型的卵圆形病灶者 98例 ( 5 7% ) ,病灶长轴与侧脑室切线垂直的病灶占总病灶一半以上者 1 30例 ( 76 % )。( 2 ) 2 0 3例MS患者中 ,大脑半球内和脑内无病灶者分别为 4 1例 ( 2 0 % )和 31例 ( 1 5 % )。仅脑干有病灶者 6例 ( 3% ) ,仅小脑有病灶者 2例 ( 1 % ) ,脑干和小脑都有病灶者 2例 ( 1 % )。 ( 3) 2 0 3例共检查 82 7例次 MRI,有活动病灶者 77例( 4 1 % ) ,共有活动病灶 2 6 1个 ,分布在大脑、小脑和脑干者依次为 2 2 3、1 0和 2 8个。结论　 ( 1 )在确诊 MS患者中 ,多数 ( 85 % )脑 MRI有脱髓鞘病灶 ,与欧美资料相近。( 2 )脑内有病灶者中 ,小脑有病灶者占 2 8% ,较欧美报道为低。 ( 3) T2像发现活动病灶的机率不高 ,多次复查能提高病灶的检出率 ( 4 1

The Characteristics of Brain Magnetic Resonance Imaging (MRI) in Patients with Multiple Sclerosis-with Special Reference to Follow-up Study of 203 Cases for Two Years

Objective To investigate the characteristics of brain magnetic resonance imaging (MRI) in patients with multiple sclerosis(MS). Methods Brain MRI T1 and T2 weighted scans taken every six months using the same MRI machine and similar parameters were studied in 203 patients (827 times) with clinically definite MS.Results Of the 203 patients with MS, there were demyelinating plaques in 172 cases (84.7%).The plaques in corpus callosum, brainstem and cerebellum were in 90 (52%), 106 (62%) and 46 (28%) cases respectively. The lesions closely adjacent to ventricle in 157(91%) cases. There were typical oval lesions in 98 (57%) cases. There were lesions, their long-axis was perpendicular with tangent line of ventricle, more than half of the total lesion in 130 (76%) cases. There were 261 active lesions in 77 (41%) patients, 223 lesions in cerebrum, 10 incerebellum and 28 in brainstem.Conclusions (1)There were85?myelinating plaques found in brain MRI of patients with clinically definite MS. It is quite similar to western reports. (2)Twenty-eight percent of 172 cases with brain demyelinating plaques revealed the lesion in cerebellum. It is much lower than that in western reports. (3)The active lesions detected by T2 weighted image were found in 41% of patientswithclinicallydefiniteMS.The detectingpositiveratecouldberaised byincreasingthedetectingfrequency.