多发性硬化的临床及MRI表现

目的阐述多发性硬化的脑部MRI表现,探讨MRI对该病的诊断价值及在判断病程方面的作用。方法符合临床诊断标准的多发性硬化患者116例,男性39例,女性77例,年龄18～56岁,其中30～40岁患者85例。116例患者均行头部MRI检查与复查,其中59例行脊髓MRI检查。结果脑部病变多发102例,多数呈对称性分布,并具有反复性及病变分布的多变性,病变主要累及脑白质,98例分布在侧脑室周围脑白质,其中11例合并脑萎缩,脑皮质及灰质核团受累4例,脑内不规则分布5例。病变均呈长T1长T2信号,大小不等,多为团状或斑片状,其中47例可见"垂直征"。脑内单发14例,其中5例单发于脑干,1例单发于小脑,4例单发于胼胝体,4例单发于半卵圆中心。72例患者行增强扫描后共可见249个强化灶,其中形态呈环形132个,团状或斑片状87个。结论多发性硬化脑部的MRI表现有一定的特征性,结合多时相病程,即可作出诊断并可判断其演变过程。

Objective To demonstrate magnetic resonance imaging （MRI） features of brain in multiple sclerosis, and to evaluated the diagnostic value and assessment of course. Method 116 cases with MS were diagnosised by clinical diagnostic criterion （39 males, 77 females, and 18-56 years, including 85 cases were 30-40 years old）. Thesell6 cases were examined and counterchecked by MRI, and MRI assessed the spinal cord of 59 cases. Results 102 cases with MS presented cerebral multiple-foci lesion, most loci were distributed symmetrically, and the loci had recurrent and variety of distribution. The foci were involved mainly in cerebral white matter. The foci of 98 cases were distributed at lateral periventricular white matter. And 11 cases were coexistence of brain atrophy. Four cases with cortex and gray nucleus mass lesion. The loci in brain of 5 cases were distributed irregularly. Foci presented long T1 and long T2 signal, size difference. Most of loci showed mass or patch form, ＂perpendicular sign＂ were presented in 47 cases. 14 cases were single focus （including 1 case in brain stem, 1 in cerebellum, 4 in callousm, and 4 in semi-ovoid center）. 249 enhancing lesions were shown by enhancing scanning in 72 cases （132 foci showed ringwise, and 87 showed mass or patch shape）. Conclusion MRI of the brain in MS is better to show the histopathologic features, on the basis of multiphasic presentation of its clinical course, it is likely to make the correct diagnosis of this disease.