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目的 寻找多发性硬化(multiplesclerosis,MS)患者有诊断及鉴别诊断意义的脑部磁共振成像(MRI)征象。方法 分析41例临床确诊MS患者的常规脑部MRI表现,内容包括病灶数目、分布、大小、形态、信号特征及增强表现等。结果 脑部的MS灶可以单发和多发,单发者幕下多见,多发者以4~15个病灶者最多。少数病例的病灶弥漫分布,无法计数,呈现“白质变脏征”。斑块分布以两侧脑室旁最多见,其次为额顶叶皮层下、胼胝体、脑干,伴发小脑内病灶仅2例。斑块直径约几个毫米至2cm不等,约占75%; 2cm以上病灶者少见,最大病灶约6~7cm。根据形态和信号,病灶可以分为急性和慢性。急性病灶呈卵圆形或圆形,有明显膨胀感,T1WI呈低或略低信号,周围可见等或略高信号;T2WI呈高信号,但增高程度不同,表现为中央呈“核心”而周围呈“晕环”。此类病灶均表现强化,最典型为环形强化、强化环完整或呈不完整弓形,即使病灶较大仍具有上述特点。慢性病灶也可分为两种,一种为大体对称性的病灶,分布于两侧脑室旁,另一种病灶分布较分散,额、顶叶,侧脑室旁及脑干等处都有,病灶呈小条、片状,部分融合成较大片状。慢性病灶有收缩感,边缘较锐利,信号较均匀,周围无晕环征象,增强后无强化。结论 脑部MS有多种MRI表现,部分征象具有特征性。
Objective To find out MRI signs of diagnosis and differential diagnosis in patients with multiple sclerosis (MS). Methods The MRI findings of routine brain MRI in 41 clinically diagnosed MS patients were analyzed, including the number of lesions, distribution, size, morphology, signal characteristics and enhanced performance. Results The brain of the MS stove can be single and multiple, single more common under the screen, mostly with 4 to 15 lesions were the most. A small number of cases of diffuse distribution of lesions, can not be counted, showing “white matter becomes dirty sign.” Plaque distribution to the most common on both sides of the ventricle, followed by the frontal cortex, the corpus callosum, brainstem, associated with cerebellar lesions only 2 cases. Plaque diameter of about a few millimeters to 2cm range, accounting for about 75%; 2cm above lesions rare, the largest lesions of about 6 ~ 7cm. According to the morphology and signal, lesions can be divided into acute and chronic. Acute lesions were oval or round, with a clear sense of expansion, T1WI was low or slightly lower signal, the surrounding visible or slightly higher signal; T2WI was high signal, but increased in different degrees, the performance of the central was “core” and around Was “halo.” Such lesions were enhanced, the most typical ring enhancement, enhanced ring integrity or incomplete bow, even if the lesion still has the above characteristics. Chronic lesions can also be divided into two kinds, one for the general symmetry of the lesion, located in the lateral ventricle, the distribution of the other lesions are scattered, the amount of parietal lobe, lateral ventricle and brain stem and other places have, lesions were Strip, flake, part of the integration into a larger flake. Chronic lesions have a sense of contraction, the edge is sharper, the signal is more uniform, no halo around the signs of enhanced without enhancement. Conclusion There are many MRI manifestations of brain MS, and some of the signs are characteristic.