脊髓型临床孤立综合征的临床及MRI分析  

Spinal Clinically Isolated Syndromes:Clinical and MRI Analysis

作　　者：李宏增[1] 张金妮[1] 李柱一[1] 

机构地区：[1]第四军医大学唐都医院神经内科,陕西西安710038

出　　处：《实用放射学杂志》2008年第12期1588-1591,1600,共5页Journal of Practical Radiology

摘　　要：目的探讨脊髓型临床孤立综合征(CIS)的临床及磁共振成像(MRI)特征。方法回顾分析63例临床早期表现为脊髓型CIS的多发性硬化(MS)患者的MRI表现及扩展的功能障碍状况量表(EDSS)评分。结果52.9%的MS患者在早期表现为脊髓型CIS,其中88.9%以急性或亚急性起病,42.9%的首发症状为孤立的感觉障碍,54.9%为颈髓受累。首次MRI阳性率达91.1%,其中35.3%存在"多灶性"损害,45.1%病变范围在2个椎体节段内,81.7%的独立病灶在矢状位的长度不超过2个椎体高度,89.0%在轴位不超过脊髓横径的1/2。基线MRI的病灶数量、面积与确诊时的EDSS评分有正相关关系;皮质类固醇激素冲击治疗前后的EDSS评分有统计学差异(P=0.003)。结论脊髓型CIS以急性、亚急性起病、颈髓受累多见,脊髓损害不完全,MRI可有"多灶"损害,早期病灶定量分析对评估预后有一定价值,皮质类固醇激素冲击治疗能有效缓解症状。Objective To evaluate the clinical manifestations and magnetic resonance imaging （MRI） features of the clinically isolated syndrome （CIS） of the spinal cord. Methods MRI features and expanded disability status scale （EDSS） score in 63 patients with multiple sclerosis （ MS ） showed early clinical manifestations of spinal CIS were retrospectively analysed . Results 52.9% of MS patients in the early performance was the spinal CIS , 88.9% was acute or subacute onset , 42.9% of the initial symptoms was isolated sensory dysfunction,and 54.9% had cervical spinal cord involvement . The first MRI positive rate was 91. 1% and 35.3% presented with ＂multifocal＂ plagues. 81.7% of the MRI lesions were not more than two vertebral segments, and 89.0% in the axial diameter of the spinal cord did not exceed 1/2. The number, volume and area of MRI lesions at baseline confirmed the positive correlation with EDSS at diagnosis of MS. Corticosteroid therapy before and after the EDSS score was of a significant difference （ P = 0. 003 ）. Conclusion Spinal CIS often occurs in cervical spinal cord with acute or subacute onset, and incomplete spinal cord injury. MRI may detect ＂multifocal＂ plagues. Quantitative MRI is valuable for the assessment of prognosis. Early intravenous corticosteroid therapy can be an effective way to ease symptoms.

关 键 词：临床孤立综合征 多发性硬化 磁共振成像 扩展的功能障碍状况量表 

分 类 号：R744.5[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]