视神经脊髓炎谱系疾病脊髓病变的临床及影像学研究

Clinical and imaging observation of spinal cord lesions in patients with neuromyelitis optica spectrum disorders

目的分析视神经脊髓炎谱系疾病(NMOSD)脊髓病变临床及影像学特点。方法选取2013年1月至2016年12月安徽医科大学第三附属医院收治的符合2015年NMOSD诊断标准国际共识、以急性脊髓炎为主要表现的NMOSD患者6例,回顾分析患者临床资料、影像学表现及特点。结果 6例患者的脊髓MRI均可见纵向延伸≥3个椎体节段的T2高信号,3例患者连续节段超过7,1例患者存在延髓受累。病灶连续横贯在脊髓中心或脊髓灰质(铺状态下选择70%位于灰质),呈对称性的圆形及H形。1例患者可见亮点灶。6例患者中脊髓肿胀有2例,3例表现为条索状,1例为斑片状。结论 NMOSD脊髓病变患者以运动障碍为主要表现,视神经受累预示着高复发几率。纵向延伸≥3个椎体节段T2高信号是NMOSD的常见表现。亮点灶对于NMOSD具有鉴别意义,早期诊断NMOSD,早期启动有效的免疫抑制治疗是预后的关键。

ObjectiveTo analyze the clinical and imaging features of spinal cord lesions in patients with neuromyelitis optica spectrum disorders MethodsSix patients following NMOSD with acute myelopathy were selected according to the international consensus on the diagnosis standard of NMOSD in the year of2015,and the clinical data,imaging features and characteristics of these four patients were summarized and analyzed.ResultsThe spinal cord MRI in six patients was observed longitudinally extending more than or equal to three vertebral segments with T2high signal,with three patientshaving segment more than seven consecutive sections.One patient had involvement of medulla.The lesions were located in the center of the spinal cord or the gray matter of the spinal cord(more than70%in the gray matter),and the shape of the lesions was circular and H symmetry.One patient was with bright spotty lesions.There were two patients with spinal cord swelling among these six patients,the shape of which was stripe and patchy.ConclusionSpinal cord lesions in patients with NMOSD mainly manifestas movement disorders.Optic nerve involvement indicates a high probability of recurrence.The longitudinal extension of more than three segments of high T2signal is a common manifestation of NMOSD.Bright spot has the distinguishing significance to NMOSD.The key to the prognosis of NMOSD is the early diagnosis and the effective immune suppression therapy.