MRI在诊断MS的作用2013.ppt

The role of MRI in the diagnosis of Multiple Sclerosis Publication date May 13, 2013 MS-主要讨论问题 典型MRI发现 McDonald标准：MRI在诊断的应用 鉴别诊断： MS-其他常见白质病变 当我们见下面病例，首先考虑是什么病？MS？高血压性小血管病？或其他更少见病？ 白质脑病: 许多神经系统疾病在临床和放射学均与MS相似 多数意外发现WMLs常为血管性 白质病变鉴别诊断太难 Typical MRI findings in MS 多发性硬化特征性发现胼胝体病灶和胼胝体周围白质病灶 characteristic finding multiple hypointense lesions in the corpus callosum Juxtacortical lesions are specific for MS Juxtacortical lesions（旁正中矢状位更清楚） Cortical lesions in a patient with relapsing–remitting MS on 3 T MRI 注意：常规序列无法显示这些皮质灶 MS常见病灶-幕下病灶 bright foci in the brainstem and cerebellum Infratentorial lesions MS典型灶-脑室周围白质高信号 multiple lesions in a distribution characteristic of MS. 多发性脊髓灶-MS另一个典型特征 24岁,单眼视力↓→数年后四肢运动感觉损害 →双下肢感觉损害就诊→MS可能 T2WI: a 27-year-old woman Dawson fingers Dawson fingers?are a radiographic feature depicting demyelinating plaques through corpus callosum, arranged at right angles along medullary veins (callososeptal location) They are a relatively specific sign for?MS, which presents as T2 hyperintensities. Typical findings a 35-year-old man with relapsing remitting MS Ovoid lesions perpendicular to the ventricles surface are common MS切片：perivenous inflammation 淋巴细胞浸润见于小静脉周围，这些淋巴细胞攻击髓鞘 MS斑三种增强类型 见于疾病急性（活动）期或亚急性斑块 三种增强类型 Solid “开环征”(open-ring sign)或称为“弓形征”(arclike sign) Ring 环形 The C-shaped or arclike enhancement, which is fairly characteristic of multiple sclerosis 女，36岁，双下肢麻木7月，无力4月 MS Variants and Differential diagnosis A 39 year old male presented with subacute onset of hemianopsia.He was referred for biopsy to differentiate between a glioma or demyelination Tumefactive MS特征 MS变异型 较大脑实质灶，占位征不如其他性质同样大小灶 增强 周围增强，常呈不完全环状，可以与表现为封闭环样增强的胶质瘤或脑脓肿区别 部分增强(开放环）+ 低信号T2环+ CBF低均提示脱髓鞘 Balo’s Concentric Sclerosis Neuromyelitis Optica Acute Disseminated Encephalomyelitis (ADEM) 选择性累及皮质，基底节和丘脑 Here another case of ADEM. 注意基底节受累 Here another case of ADEM The McDonald criteria for MS Poser- Diagnosis conclusions The criteria can yield five conc