MOG抗体相关脑脊髓炎MRI表现及误诊分析

MRI Manifestations and Misdiagnosis Aanalysis of MOG Antibody Associated Encephalomyelitis

目的探讨12例MOG抗体相关脑脊髓炎MRI平扫及增强影像学表现,从而降低影像诊断误诊率。方法收集经临床最终证实的12例MOG抗体相关脑脊髓炎患者的临床及MRI影像资料,12例患者均行MRI平扫及增强检查,通过分析患者性别、发病年龄、临床症状、发病部位及病变数目、病变平扫及强化特征,总结影像学征象,分析误诊原因,提高影像诊断准确率。结果(1)男性3例,女性9例,年龄19-41岁,中位年龄27.5岁;(2)12例患者均有头晕头痛症状,其中听力减退伴吞咽困难2例,肢体麻木5例,癫痫4例,排尿障碍1例,意识水平下降7例,12例均无视神经症状;(3)其中1例为单发病变,其余11例为多发,12例患者共39个病灶,病变主要累及额叶(5/39)、颞叶(3/39)、枕叶(2/39)、顶叶(3/39)、岛叶(2/39)胼胝体(2/39)、脑桥(6/39)、脑桥臂(8/39)、大脑脚(1/39)小脑半球(1/39)、脊髓(6/39);MRI病变平扫39个病灶均表现为斑片状T_(1)WI低信号、T_(2)WI高信号;33个脑实质内病灶,其中DWI高信号(31/33)、DWI等信号(2/33),累及皮层下U型纤维(15/33),增强病变呈斑片状强化(14/39)、条纹状强化(5/39)、开环状强化(16/39)、无强化(4/39)。12例患者在影像诊断中均出现误诊,其中4例误诊为脑梗死、3例误诊为NMOSD、2例误诊为ADEM、2例误诊为胶质瘤、1例误诊为淋巴瘤。结论MOG抗体相关脑脊髓炎主要发生于中青年人群,女性多发,病变多累及大脑半球皮层下U型纤维、脑桥、脑桥臂及脊髓,DWI多呈高信号,增强呈斑片状、条纹状、开环状强化为其特点。

Objective To investigate the plain MRI and contrast-enhanced MRI findings of 12 cases of MOG antibody associated encephalitis,so as to reduce the misdiagnosis rate of imaging diagnosis.Methods The clinical and MRI imaging data of 12 patients with MOG antibody related encephalomyelitis finally clinically confirmed were collected.All the 12 patients underwent plain MRI and contrast-enhanced MRI examinations.By analyzing the gender,age of onset,clinical symptoms,location and number of lesions,plain MRI and contrast-enhanced performance of lesions,imaging characteristics were summarized and causes of misdiagnosis were analyzed in order to improve the diagnostic accuracy.Results(1)There were 3 males and 9 females,age ranged 19-41 yearswith a median age of 27.5 years;(2)All the 12 patients had dizziness and headache symptoms,including hearing loss with dysphagia in 2 cases,limb numbness in 5 cases,epilepsy in 4 cases,dysuria in 1 case,decreased consciousness in 7 cases,and no neurological symptoms in 12 cases;(3)One patient had single lesion,and the other 11 patients had multiple lesions.Twelve patients had 39 lesions,mainly involving the frontal lobe(5/39),temporal lobe(3/39),occipital lobe(2/39),parietal lobe(3/39),insular lobe(2/39),corpus callosum(2/39),pons(6/39),pontine arm(8/39),greater peduncle(1/39),cerebellar hemisphere(1/39),and spinal cord(6/39).On plain MRI,39 lesions showed patchy hypointensity on T_(1)WI and hyperintensity on T_(2)WI.Thirty-three lesions were in brain parenchyma,including DWI hyperintensity(31/33)and isointensity(2/33),involving subcortical U-shaped fibers(15/39),and enhanced lesions showed patchy enhancement(14/39),stripe like enhancement(5/39),open ringenhancement(16/39),and no enhancement(4/39).Tweleve patients were misdiagnosed in initial imaging diagnosis,including 4 patients misdiagnosed as cerebral infarction,3 patients misdiagnosed as NMOSD,2 patients misdiagnosed as ADEM,2 patients misdiagnosed as glioma,and 1 patient misdiagnosed as lymphoma.Conclusion MOG antibody associated encephalomyelitis mainly occurs in young and middle-aged people,usually in female.The lesions mostly involve the U-shaped fibers under the cerebral cortex,pons,pontine arms and spinal cord.MR imaging features are characterized by hyperintensity in DWI and patchy,striped and open ring enhancement.