多发性硬化与视神经脊髓炎患者磁共振检查的对比研究
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摘要
目的探讨MRI对多发性硬化(MS)和视神经脊髓炎(NMO)的鉴别价值。方法92例MS患者(MS组)和57例NMO患者(NMO组)在发病急性期(发病30 d内)均接受了头颅MRI扫描,其中49例MS患者和57例NMO患者还接受了全脊髓MRI扫描,比较2组MRI表现的差异。结果 MS患者和NMO患者的MRI表现存在多种差异,NMO组头颅病灶的检出率明显低于MS组(57.89%vs.96.74%,P<0.05)。相比NMO组,MS组更多患者符合Barkhof空间多发标准(59.78%vs.8.77%,P<0.05)。NMO组强化病灶、皮层下病灶、小脑病灶出现率均少于MS组(P均<0.05)。NMO患者脊髓病灶的出现率、出现强化、脊髓肿胀率及线样征的出现率均高于MS组,病灶纵向长度明显超过MS患者(P均<0.05)。结论 MRI对MS和NMO有较高的鉴别价值。
Objective To evaluate the differential diagnostic value of magnetic resonance imaging( MRI) between multiple sclerosis( MS) and neuromyelitis optica( NMO). Methods Ninety two MS( MS group) and 57 NMO patients( NMO group) underwent head MRI during the acute onset stage( within 30 d after onset). Among them,49 MS and 57 NMO cases received spinal MRI. The MRI characteristics between two groups were statistically compared. Results The MRI findings significantly differed between the MS and NMO patients. Compared with the NMO group,MS patients had a significantly higher risk of brain lesion( 96. 74%vs. 57. 89%,P < 0. 05),and a significantly higher proportion of MS patients met Barkhof criteria( 59. 78%vs. 8. 77%,P < 0. 05). The incidence of enhanced lesion,subcortical lesion and cerebellar lesion in the NMO group was considerably lower compared with that in the MS group( all P < 0. 05). Compared with MS patents,NMO counterparts had a significantly higher incidence of spinal cord lesion,enhanced lesion,spinal cord edema and string signs and a considerably larger vertical diameter of the lesion( all P < 0. 05). Conclusion MRI examination is of clinical significance in the differential diagnosis between MS and NMO.
Objective To evaluate the differential diagnostic value of magnetic resonance imaging( MRI) between multiple sclerosis( MS) and neuromyelitis optica( NMO). Methods Ninety two MS( MS group) and 57 NMO patients( NMO group) underwent head MRI during the acute onset stage( within 30 d after onset). Among them,49 MS and 57 NMO cases received spinal MRI. The MRI characteristics between two groups were statistically compared. Results The MRI findings significantly differed between the MS and NMO patients. Compared with the NMO group,MS patients had a significantly higher risk of brain lesion( 96. 74%vs. 57. 89%,P < 0. 05),and a significantly higher proportion of MS patients met Barkhof criteria( 59. 78%vs. 8. 77%,P < 0. 05). The incidence of enhanced lesion,subcortical lesion and cerebellar lesion in the NMO group was considerably lower compared with that in the MS group( all P < 0. 05). Compared with MS patents,NMO counterparts had a significantly higher incidence of spinal cord lesion,enhanced lesion,spinal cord edema and string signs and a considerably larger vertical diameter of the lesion( all P < 0. 05). Conclusion MRI examination is of clinical significance in the differential diagnosis between MS and NMO.
引文
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[7]Matsushita T,Matsuoka T,Ishizu T,Kikuchi H,Osoegawa M,Kawano Y,Mihara F,Ohyagi Y,Kira J.Anterior periventricular linear lesions in optic-spinal multiple sclerosis:a combined neuroimaging and neuropathological study.Mult Scler,2008,14(3):343-353.
[8]Cai W,Tan S,Zhang L,Shan Y,Wang Y,Lin Y,Zhou F,Zhang B,Chen X,Zhou L,Wang Y,Huang X,Men X,Li H,Qiu W,Hu X,Lu Z.Linear lesions may assist early diagnosis of neuromyelitis optica and longitudinally extensive transverse myelitis,two subtypes of NMOSD.J Neurol Sci,2016,15(360):88-93.
[9]Filippi M,Rocca MA,Ciccarelli O,De Stefano N,Evangelou N,Kappos L,Rovira A,Sastre-Garriga J,TintorèM,Frederiksen JL,Gasperini C,Palace J,Reich DS,Banwell B,Montalban X,Barkhof F;MAGNIMS Study Group.MRI criteria for the diagnosis of multiple sclerosis:MAGNIMS consensus guidelines.Lancet Neurol,2016,15(3):292-303.
[10]Cossburn M,Tackley G,Baker K,Ingram G,Burtonwood M,Malik G,Pickersgill T,te Water NaudéJ,Robertson N.The prevalence of neuromyelitis optica in South East Wales.Eur J Neurol,2012,19(4):655-659.
[11]Asgari N,Lillevang ST,Skejoe HP,Falah M,Stenager E,Kyvik KO.A population-based study of neuromyelitis optica in Caucasians.Neurology,2011,76(18):1589-1595.
[12]Pandit L,Kundapur R.Prevalence and patterns of demyelinating central nervous system disorders in urban Mangalore,South India.Mult Scler,2014,20(12):1651-1653.
[2]Wingerchuk DM,Lennon VA,Pittock SJ,Lucchinetti CF,Weinshenker BG.Revised diagnostic criteria for neuromyelitis optica.Neurology,2006,66(10):1485-1489.
[3]秦军,高勇安,秦文.多发性硬化和视神经脊髓炎视神经病变MRI研究.临床放射学杂志,2015,34(3):337-340.
[4]胡冰,杨洋,邹艳,康庄,邝思驰,罗琳,沈敏,单鸿.磁共振波谱和扩散张量成像对多发性硬化的诊断.新医学,2010,41(10):640-644.
[5]Kim SH,Kim W,Li XF,Jung IJ,Kim HJ.Clinical spectrum of CNS aquaporin-4 autoimmunity.Neurology,2012,78(15):1179-1185.
[6]Rueda Lopes FC,Doring T,Martins C,Cabral FC,Malfetano FR,Pereira VC,Alves-Leon S,Gasparetto EL.The role of demyelination in neuromyelitis optica damage:diffusion-tensor MR imaging study.Radiology,2012,263(1):235-242.
[7]Matsushita T,Matsuoka T,Ishizu T,Kikuchi H,Osoegawa M,Kawano Y,Mihara F,Ohyagi Y,Kira J.Anterior periventricular linear lesions in optic-spinal multiple sclerosis:a combined neuroimaging and neuropathological study.Mult Scler,2008,14(3):343-353.
[8]Cai W,Tan S,Zhang L,Shan Y,Wang Y,Lin Y,Zhou F,Zhang B,Chen X,Zhou L,Wang Y,Huang X,Men X,Li H,Qiu W,Hu X,Lu Z.Linear lesions may assist early diagnosis of neuromyelitis optica and longitudinally extensive transverse myelitis,two subtypes of NMOSD.J Neurol Sci,2016,15(360):88-93.
[9]Filippi M,Rocca MA,Ciccarelli O,De Stefano N,Evangelou N,Kappos L,Rovira A,Sastre-Garriga J,TintorèM,Frederiksen JL,Gasperini C,Palace J,Reich DS,Banwell B,Montalban X,Barkhof F;MAGNIMS Study Group.MRI criteria for the diagnosis of multiple sclerosis:MAGNIMS consensus guidelines.Lancet Neurol,2016,15(3):292-303.
[10]Cossburn M,Tackley G,Baker K,Ingram G,Burtonwood M,Malik G,Pickersgill T,te Water NaudéJ,Robertson N.The prevalence of neuromyelitis optica in South East Wales.Eur J Neurol,2012,19(4):655-659.
[11]Asgari N,Lillevang ST,Skejoe HP,Falah M,Stenager E,Kyvik KO.A population-based study of neuromyelitis optica in Caucasians.Neurology,2011,76(18):1589-1595.
[12]Pandit L,Kundapur R.Prevalence and patterns of demyelinating central nervous system disorders in urban Mangalore,South India.Mult Scler,2014,20(12):1651-1653.