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目的分析我国多发性硬化病例典型及不典型影像学改变。方法回顾经McDonald诊断标准明确诊断的82例多发性硬化患者的头部MRI检查结果,分析病灶部位、大小、数目、形状、信号强度及强化方式等。结果我国多发性硬化的典型影像学表现:(1)病灶部位以脑室旁(62例,75.61%)及幕上深部白质(55例,67.07%)多见。(2)病灶数目多在10个以上(62例,75.61%)。(3)病灶直径以≤1 cm为主(62例,75.61%),>5 cm次之(23例,28.05%)。(4)信号强度及强化特征为T_1WI平扫呈等或略低信号,T_1WI高信号,PDwI高于脑脊液中水信号;T_1WI增强图像黑洞从微小至大片状均可见,形状多呈类圆形或条片状;<1 cm病灶显示结节状强化,1～5 cm病灶一般呈环状强化,>5 cm病灶以边缘强化或内部呈不规则环状强化为主,皮质病灶多见弓状强化。我国多发性硬化的不典型影像学表现为:病灶较大,最大直径>5 cm(23例,28.05%);强化显著且强化持续时间较长;脑干病灶多见(61例,74.39%)。结论侧脑室旁或深部白质内多发小病灶是多发性硬化的典型MRI表现;侧脑室旁病灶致侧脑室变形、大脑凸面的微小黑洞及侧脑室边缘的条片状黑洞,以及近皮质或围绕侧脑室颞角的弓状强化具有重要诊断价值。病灶大、强化显著及脑干病灶多见,是我国多发性硬化不同于欧美地区的主要表现。
Objective To analyze the typical and atypical radiological changes of multiple sclerosis cases in China. Methods The MRI findings of 82 patients with multiple sclerosis diagnosed by McDonald ’s diagnostic criteria were retrospectively analyzed. The lesion location, size, number, shape, signal intensity and intensifying pattern were analyzed. Results The typical radiological manifestations of multiple sclerosis in China were as follows: (1) The lesions were mainly seen in the periventricular (62 cases, 75.61%) and deep supratentorial white matter (55 cases, 67.07%). (2) The number of lesions in more than 10 (62 cases, 75.61%). (3) The diameter of lesion was ≤1 cm (62 cases, 75.61%), followed by> 5 cm (23 cases, 28.05%). (4) The signal intensity and enhancement characteristics of T_1WI scan were equal or slightly lower signal, T_1WI high signal and PDwI were higher than those in cerebrospinal fluid. T_1WI enhanced image black holes were visible from tiny to large plate, Or strip-like; <1 cm lesions showed nodular enhancement, 1 ~ 5 cm lesions generally ring-like enhancement,> 5 cm lesion edge enhancement or internal irregular ring-shaped enhancement mainly cortical lesions more arched strengthen. Atypical radiological findings of multiple sclerosis in our country were as follows: the lesion size was larger, the maximum diameter was> 5 cm (23 cases, 28.05%); the enhancement was significant and the duration of enhancement was longer; the lesions of the brain stem were more common (61 cases, 74.39% . Conclusions Multiple lesions in the lateral ventricle or in the deep white matter are typical MRI manifestations of multiple sclerosis. Lateral ventricular lesions cause lateral ventricular degeneration, small black holes in the convex surface of the brain and lamellar black holes at the margins of the lateral ventricle, The arch of the temporal horn of the ventricle has important diagnostic value. Large lesions, significant enhancement and brain stem lesions more common, is China’s multiple sclerosis is different from the main performance in Europe and the United States.