AQP4阳性的视神经脊髓炎谱系疾病侧脑室白质损伤的影像学特点

Imaging features of lateral ventricular white matter hyperintensity in AQP4-positive neuromyelitis optica spectrum disease

目的探讨AQP4阳性的视神经脊髓炎谱系疾病(NMOSD)侧脑室白质损伤的影像学特点。方法回顾性收集同时期就诊的63例AQP4阳性的NMOSD和55例多发性硬化(MS)患者的临床资料,所有患者于急性期行脑磁共振(MRI)显示有侧脑室白质损伤。对2组临床资料及侧脑室白质损伤的分布、形态、强化方式等影像特点进行比较,总结AQP4阳性的NMOSD侧脑室白质损伤的MRI特点。结果与MS相比,NMOSD患者发病年龄、EDSS评分更高(P<0.05)。NMOSD患者病灶好发于侧脑室体部(69.8%)和后角(61.9%),但发生率低于MS,比MS更易发生单侧(42.9%)病灶和线或条带状(42.9%)病灶,更少发生道森指型(17.5%)病灶,Fazekas评分中的PVH分级更低[3(2,3)](P<0.05)。行增强扫描时,NMOSD(45.5%)比MS强化率低,出现环状或结节状强化(6.7%)更少,更多出现线状强化(46.7%)(P<0.05)。仅在NMOSD发现云雾状(13.3%)和脑膜强化(6.7%),仅在MS(6.3%)发现边缘强化,2组斑片状病灶、斑片状强化方式对比差异无统计学意义(P>0.05)。结论NMOSD具有特征性的侧脑室白质损伤表现,好发于体部和后角,比MS更易出现单侧损害且损伤程度更轻。线或条带状病灶、线状强化、强化率低是其特异性表现,云雾状强化和脑膜强化虽有特异性但发生率低,而对诊断MS特异的道森指型病灶和环状强化在NMOSD中也可发生。

Objective To investigate the imaging features of lateral ventricular white matter hyperintensity in AQP4-positive neuromyelitis optica spectrum disease(NMOSD).Methods The medical records of 63 AQP4-positive NMOSD patients and 55 MS patients during the same period were retrospectively collected.All pa⁃tients underwent brain magnetic resonance imaging(MRI)in the acute phase and the imaging showed lateral ven⁃tricular white matter hyperintensity.The clinical data and the imaging features of the lesion distribution,morpholo⁃gy and enhancement were compared,and then the MRI features of the AQP4-positive NMOSD were summarized.Results Compared with MS,the onset age and EDSS score of NMOSD were higher(P<0.05).NMOSD lesions mainly occurred in the body(69.8%)and posterior horn(61.9%)of lateral ventricle,but the incidence was lower than that of MS.NMOSD was more likely to have unilateral(42.9%)and linear or banded(42.9%)lesions than MS,and less likely to have Dawson’s finger lesions(17.5%).The PVH grading of Fazekas in NMOSD[3(2,3)]was lower(P<0.05).When performing enhanced scanning,NMOSD(45.5%)had a lower enhancement rate,less ring or nodular enhancement(6.7%),and more linear enhancement(46.7%)than MS(P<0.05).Cloud-like(13.3%)enhancement and meningeal enhancement(6.7%)were found only in NMOSD,and marginal enhance⁃ment was found only in MS(6.3%).There was no significant difference in patchy lesions and patchy enhancement between the two groups(P>0.05).Conclusion NMOSD has characteristic performance of lateral ventricle white matter lesions,which mainly occurs in the body and posterior horn,and is more prone to unilateral damage and less severe damage than MS.Linear or banded lesions,low enhancement rate and linear enhancement are the spe⁃cific manifestations of NMOSD.Cloud-like enhancement and meningeal enhancement are also specific but have a low incidence.Dawson’s finger lesions and ring enhancement that are specific for the diagnosis of MS are also found in NMOSD.