Balo同心圆硬化的MRI和功能MRI表现

MRI and fMRI Manifestations of Balo's Concentric Sclerosis

目的:探讨常规MRI、扩散张量成像和MRS对Balo同心圆硬化(BCS)的诊断价值。方法:分析4例BCS的MRI表现,并与病理结果进行对照,其中行MR扩散张量成像和质子磁共振波谱(1H-MRS)检查各1例。结果:4例中MRI显示13个病灶,3例多发,1例单发。9个病灶呈典型同心圆或洋葱皮样改变,T1WI上呈等信号和低信号交替环,FLAIR序列T2WI上呈等信号和高信号相间,与病理显示的病灶严重脱髓鞘区和髓鞘保留区相间排列的特点一致。1例1H-MRS示病变区NAA降低、Cho升高。1例DWI显示病变不同信号区FA值均低于对侧正常白质,且病变中心区、T1WI和T2WI上显示的等信号带、T2WI上高信号带及病灶周围的FA值存在差异(P<0.05)。纤维束扩散张量成像显示纤维束在病变区部分中断。结论:MRI能反映BCS的病理改变,对BCS活体、无创诊断具有重要意义,DWI和MRS可以作为评价BCS进展、预后和判断疗效的一种成像方法。

Objective： To study the manifestations and diagnostic value of MRI,^1H MRS and diffusion tensor imaging （DTI） in Balo＇s concentric sclerosis （BCS）. Methods： The MRI features of brain in four patients with BCS were reviewed and correlated with pathology findings. One patient had ^1H-MRS,and DTI was performed in another patient. Results：There were altogether 13 lesions showed on MRI,with 3 patients had multiple lesions and 1 patient had solitary lesion. 9 lesions appeared as characteristic concentric onion-like layering structure, alternated iso and hypo intense rings were assessed on T1 WI and alternated iso and hyper-intense rings on FLAIR T2 WI, which were in consistent with the arrangement of alter hated demyelinated and preserved myelination areas found in pathology. Of the 1 patient had ^1H-MRS,decreasd NAA peak and increased choline peak were showed. Of the 1 patient had DTI,the FA value of lesions with different signal intensities were lower than that of contra lateral white matter. Furthermore, the FA values showed significant statistical differences between center of lesion,iso-intense zones on T1 WI as well as T2 WI,hyper-intense zone on T2 WI and surrounding of the le sion. Part of the fasciculus discontinued within the lesion. Conclusion：The pathology of BCS can be reflected on MRI,which is a non invasive diagnosis technique in vivo. DTI and MRS can be used as imaging techniques to evaluate the progression, prognosis and treatment effect of BCS.