多系统萎缩的临床与影像学分析

Clinical and neuroimage analysis on multiple system atrophy

目的 探讨多系统萎缩(MSA)的临床特点、影像学特征与临床表现的相关性,为临床诊断提供依据。方法 按Gilman诊断标准,回顾性分析26例MSA病人临床资料、一般辅助检查结果及脑CT、MRI资料。结果 拟诊MSA 21例,可能MSA 5例,其巾橄榄桥脑小脑萎缩(OPCA)14例,Shy-Drager综合征(SDS)8例,纹状体黑质变性(SND)4例。MRI显示OPCA的主要病变部位在小脑、桥脑、延髓;SDS仅部分有小脑病变,大部分正常;SND主要病变在壳核,而小脑、桥脑、延髓病变不明显。脑CT改变均不明显。结论 临床表现与MRI结合可提高MSA中OPCA、SND的诊断率,在SDS病人MRI改变不明显。一般辅助检查、脑CT对MSA诊断意义不大。

Objective To analyse clinical manifestations as well as correlation between clinical manifestations and neuroimage for correct diagnosis of multiple system atrophy(MSA). Methods 26 cases of MSA based on Gilman diagnostic criteria were retrospectively analysed in clinical materials, accessory examinations including CT and MR1 findings. Results 21 cases were probably diagnosed as MSA, another 5 cases were possible MSA. Among the 26 cases, 14 cases were olivopontocerebellar atrophy (OPCA), 8 cases Shy-Drager syndrome(SDS) and 4 cases striatonigral degeneration(SND). MRI showed that main lesion of OPCA were in cerebellum, pons, medulla, SDS in cerebellum and SND in putamen. Brain CT showed no obvious change. Conclusion The diagnostic accordance rate of OPCA and SND can be elevated with correlation between clinical manifestations and brain MRI. General accessory examinations and brain CT have little help in diagnosis of MSA.