脊髓型多发性硬化的诊断(附22例报告)  

Diagnosis of Spinal Multiple Sclerosis(22 Cases Report)

作　　者：闵宝权[1] 贾建平[1] 楚长彪[1] 王海涛[1] 张新卿[1] 杨小平[2] 李坤成[2] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]首都医科大学宣武医院放射科,北京100053

出　　处：《中国神经免疫学和神经病学杂志》2002年第3期168-171,共4页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的　探讨脊髓型多发性硬化 (MS)的临床和影像学特点及其诊断意义。方法　对 2 2例脊髓型 MS的临床特点和磁共振 (MRI)结果进行回顾性分析。结果　脊髓型 MS,占同期 MS住院患者的 1 1 .8%。女性比例较高 ,多见于中年发病 ,常以急性或亚急性起病 ,表现为复发 -缓解或慢性进展病程 ,最常累及中高位颈髓和中段胸髓 ,大多复发仍局限于原发部位。MRI特点为髓内散在的长 T1、长 T2斑块状病灶 ,其长度一般小于 2个椎体的长度 ,位于脊髓的后外侧 ,面积小于脊髓横截面的 1 /2。应用糖皮质激素试验性治疗对诊断 ,尤其是对首次发病时脊髓出现可疑脱髓鞘病灶者诊断有一定帮助。结论　诊断脊髓型 MS主要依据其临床表现 ,MRI为最敏感的检查方法 ,激素试验性治疗有时是必要的。Objective To analyze the clinical and MRI characteristics of spinal form of multiple sclerosis(MS) and assess their significance for the diagnosis. Methods A retrospective analysis was conducted for the clinical and MRI characteristics of 22 cases of spinal MS showing solely spinal symptomatology throughout the courses of the disease. Results About 11 8% of hospitalized MS cases were spinal MS,which were most seen in middle aged females, with acute or sub acute onset and developed with remissions/ relapses and/or chronic progression. The upper and middle segments of cervical and thoracic spinal cord were exclusively involved and most of the relapses have predilection for the original lesions. Intra spinal demyelinating plaques shown by MRI had hypo/isointensity on T1WI and hyperintensity on T2WI. The majority of the plaques were two vertebral body segments in length or less and posteriolaterally located, and occupied less than 50% of the cross sectional area of the spinal cord. The effect of glucocorticoids might also be of help for the diagnosis of spinal MS, especially for the suspected cases. Conclusions The diagnosis of spinal MS relied mainly on its clinical characteristics while MRI was the most sensitive method to visualize plaques in the spinal cord and occasionally a trial therapy with glucocorticoids was needed.

关 键 词：磁共振 MS 影像学特点 病例分析 脊髓型多发性硬化 诊断 

分 类 号：R744.51[医药卫生—神经病学与精神病学]