视神经脊髓炎脊髓损害的磁共振研究

Magnetic resonance imaging of spinal cord lesion in neuromyelitis optica

目的分析视神经脊髓炎(NMO)和多发性硬化(MS)患者脊髓MRI特点,以及血清抗水通道蛋白4(AQP4)IgG抗体阳性与阴性NMO患者脊髓MRI特点。方法回顾分析贵州省中枢神经系统脱髓鞘疾病数据库中42例NMO和32例有脊髓损害的MS患者的脊髓MRI资料。结果与MS组比较,NMO患者脊髓病灶累及更长的椎体节段(P<0.05),在脊髓MRI矢状位上表现为线样征和纵向延展的脊髓损害(LESCL)(P<0.05)。轴位T2WI上亮斑状损害(BSLs)以及中心性、横贯性脊髓损害更常见(P<0.05);在病灶部位及强化病灶上,NMO和MS组间比较差异无统计学意义。与血清抗AQP4-IgG抗体阴性NMO患者比较,阳性患者线样征、BSLs、中心性损害更常见(P<0.05),在脊髓病灶部位、受累椎体节段数、LESCL、横贯性损害及强化病灶方面,抗AQP4-IgG抗体阳性组和阴性组间比较差异无统计学意义。结论除LESCL、线样征、横贯性损害和中心性损害特点外,BSLs可能是另一个有助于鉴别NMO与MS的脊髓病灶MRI特征。BSLs、线样征、中心性损害特点可能与NMO患者抗AQP4-IgG抗体的血清学状态有关。

Objective To investigate the characteristics of spinal magnetic resonance imaging （MRI） in patients with neuromyelitis optica （NMO） and in patients with multiple sclerosis （MS）, as well as in patients with seropositivity for anti-aquaporin-4 （AQP4） IgG antibody and in anti-APQ4-IgG-negative patients with NMO. Methods We retrospectively analyzed spinal MRI data derived from 42 NMO patients and 32 MS patients with spinal cord lesions. All patients came from the database of demyelinating disease of central nervous system in Guizhou Province. Results Compared to MS, NMO affected longer vertebral segments in the spinal cord （P〈 0.05）, were inclined to present linear lesions and longitudinally extensive spinal cord lesions （LESCL） （P〈 0.05） on sagittal MRI. Bright spotty lesions （BSLs）, central lesions, and transverse lesions on axial T2WI were more frequently found in NMO patients （P〈0.05）. There were no difference in the respects of involved locations and gadolinium enhanced lesions between the two groups. Compared to serum anti-APQ4-IgG-negative NMO patients, linear lesions, BSLs and central lesions were more frequently found in anti-APQ4-IgG-positive patients （P〈0.05）. There were no significant difference between anti-APQ4-IgG-positive and negative patients regarding involved locations, affected vertebral segments, LESCL, transverse lesions and gadolinium enhance lesions. Conclusions In addition to LESCL, liner lesions, central lesions and transverse lesions, BSLs is another feature of NMO on spinal MRI, which is helpful to differentiate NMO from MS. The emergence of BSLs, linear lesions and central lesions on spinal MRI seems associated with the serological status of anti-AQP4 IgG antibody.