脊髓MRI对多发性硬化的诊断和鉴别诊断价值

The Spinal Cord MRI Diagnosis and Differential Diagnosis of Multiple Sclerosis

目的探讨脊髓MRI对多发性硬化(MS)的诊断和鉴别诊断价值。资料与方法80例早期MS患者作为研究对象,作脑部和脊髓MRI检查,分析脊髓和脑部病灶的特征,脊髓病变的发病率与MS诊断的相关性。结果(1)80例脊髓检查中,脊髓异常者65例(81.25%),其中颈髓18例(27.69%),胸髓13例(20.0%),腰骶髓5例(7.69%),颈髓和胸髓同时受累29例(44.62%)。(2)脊髓局灶性病灶37例(46.25%),弥漫性11例(13.75%),局灶并弥漫性病灶17例(21.25%)。(3)不联合脊髓病灶53例可诊断为MS,敏感性为66.25%,若1个脊髓病灶替代1个脑部病灶,68例可诊断为MS,敏感性为85%,两者差异具有统计学意义(P<0.05)。结论脊髓MRI可显示MS在空间的播散性,能提高MS诊断的敏感性也有助于对MS的鉴别诊断。

Objective To discuss the value of spinal cord MRI in the diagnosis and differential diagnosis of multiple sclerosis. Materials and Methods 80 patients with early stage MS were examined by MRI. The image appearances of lesions in brain and spinal cord were analyzed, and the correlations between the prevalence of spinal cord abnormalities and the diagnosis of multiple sclerosis were also analyzed. Results （ 1 ） Among 80 cases, abnormal spinal cord MR appearance were found in 65 cases （81.25%）, including cervical spinal cord in 18 cases （27.69%） ,thoracic cord in 13 cases （ 20.0% ） ,lamber and sacral cord in 5 cases （7.69%）, both cervical and thoracic cord in 29 cases （44.62 % ）. （2） Focal spinal cord lesions were found in 37 cases （46.25%） ,diffuse spinal cord abnormalities in 11 cases （ 13.75% ） ,focal and diffuse spinal cord abnormalities in 17 cases （21.25%）. （3） If spinal cord lesions were not considered,53 cases were diagnosed for multiple sclerosis ,the sensitivity was 66.25%, if a focal spinal cord lesion was substituted for one brain lesion,68 cases can be diagnosed,the sensitivity was 85 % ,which had significantly difference. Conclusion MRI can provide more evidences of multiple sclerosis dissemination in space, it also improves the sensitivity of the diagnosis and differential diagnosis of multiple sclerosis.