Sailer M, Fazekas F, Gass A, Kappos L, Radue E-W, Rieckmann P, Toyka K, Wiendl H, Bendszus M
Neurologische Universitätsklinik, Otto-von-Guericke-Universität, Magdeburg.
Rofo. 2008 Nov;180(11):994-1001. doi: 10.1055/s-2008-1027817. Epub 2008 Oct 20.
Magnetic resonance imaging (MRI) has become a valuable tool for diagnosing and monitoring multiple sclerosis (MS). The high sensitivity for the detection of hyperintense lesions in T 2-weighted scans contributes substantially to diagnosis. The initial lesion number or lesion volume stands for an increased probability of further accumulation of lesion burden, an earlier conversion to clinically definite MS and progression of disability in the next 5 - 15 years. This diagnostic and prognostic information gained from MRI early in the disease course lead in 2001 to a revision of the diagnostic criteria.
For the first time MRI criteria were defined in addition to the clinical and paraclinical criteria using the clinical terms for dissemination with respect to space and time. In particular, the defined MRI criteria are based on lesion number and location, the appearance of new lesions and lesion enhancement using contrast agent.
Reliable detection and description of older and new lesions in the disease course by MRI represents subclinical disease activity which can substitute the clinical confirmation of a relapse leading to an earlier diagnosis. This places importance on the assessment of the subclinical disease activity in sequential MR scans requiring a standardized and reproducible approach to minimize variability despite different MR scanners.
This review provides an updated proposal for the approach and management of cranial and spinal MR scans in patients with MS. We describe the influence of variables which cannot be standardized (scanner, field strength, manufacturer and software) and outline potential pitfalls of clinical MR imaging in MS resulting from a non-standardized approach. This updated proposal for slice positioning, sequences and documentation is a result of a consensus process targeting systematic and standardized use in clinical MR evaluations of MS.
磁共振成像（MRI）已成为诊断和监测多发性硬化症（MS）的重要工具。T2加权扫描对检测高信号病变具有高灵敏度，这对诊断有很大帮助。初始病变数量或病变体积表明病变负担进一步累积、在接下来5至15年内更早转化为临床确诊MS以及残疾进展的可能性增加。在疾病病程早期从MRI获得的这种诊断和预后信息在2001年导致了诊断标准的修订。
除了临床和辅助临床标准外，首次使用关于空间和时间播散的临床术语定义了MRI标准。特别是，所定义的MRI标准基于病变数量和位置、新病变的出现以及使用造影剂后的病变强化情况。
MRI对疾病病程中陈旧性和新病变进行可靠检测和描述代表了亚临床疾病活动，其可替代复发的临床确认从而实现更早诊断。这凸显了在连续MR扫描中评估亚临床疾病活动的重要性，这需要一种标准化且可重复的方法，以尽量减少尽管MR扫描仪不同但仍存在的变异性。
本综述为MS患者的头颅和脊柱MR扫描方法及管理提供了更新建议。我们描述了无法标准化的变量（扫描仪、场强、制造商和软件）的影响，并概述了因非标准化方法导致的MS临床MR成像的潜在陷阱。这份关于切片定位、序列和记录的更新建议是针对在MS临床MR评估中进行系统和标准化使用的共识过程的结果。
