Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Neuroradiol. 2019 Dec;29(4):639-644. doi: 10.1007/s00062-018-0721-1. Epub 2018 Aug 23.
The difficult differentiation between multiple sclerosis (MS) lesions and cervical spondylotic myelopathy (CSM) in the cervical spine is well known. The magnetic resonance imaging (MRI) appearance of both lesions is similar, and clinical parameters are usually used for diagnosis. The objective was to establish a reliable radiologic paradigm for diagnosis of demyelinating lesions in the cervical spine.
The MRI studies of 33 patients with MS (42 lesions) and 55 patients with CSM (60 lesions) were obtained. Lesions were evaluated for vertebral level, lesion location and size in the sagittal and axial planes, cord thickness, well-defined or ill-defined borders, presence of edema and enhancement with gadolinium. Significant differences were used to create a paradigm, which was used for the evaluation of a different group of 32 MRIs with 42 concomitant MS and CSM lesions.
Significant differences were seen in the level, location within the cord in both planes, lesion size, cord thickness and lesion border. The MS lesions were well-defined lesions found in C1-3, posterior in the sagittal plane, central in the axial plane, with a normal or increased cord thickness. Good agreement was seen in the validation stage.
The new CSM-MS lesion score allows accurate diagnosis of demyelinating lesions in the cervical spine vs. CSM lesions.
众所周知，多发性硬化症（MS）病变与颈椎脊髓型颈椎病（CSM）之间的鉴别存在困难。两种病变的磁共振成像（MRI）表现相似，通常使用临床参数进行诊断。本研究旨在建立一种可靠的影像学诊断模式，用于诊断颈椎脱髓鞘病变。
我们对 33 例 MS 患者（42 个病灶）和 55 例 CSM 患者（60 个病灶）的 MRI 研究进行了评估。对病灶的椎体水平、矢状面和轴面的位置和大小、脊髓厚度、边界清晰或不清晰、水肿和钆增强的存在进行了评估。利用显著差异创建了一个模式，用于评估另一组 32 例 MRI 中 42 个同时存在的 MS 和 CSM 病变。
在病变水平、矢状面和轴面的脊髓内位置、病变大小、脊髓厚度和病变边界方面存在显著差异。MS 病变为 C1-3 水平的边界清晰的病变，矢状面位于后部，轴面位于中央，脊髓厚度正常或增加。在验证阶段，观察到了良好的一致性。
新的 CSM-MS 病变评分可准确诊断颈椎脱髓鞘病变与 CSM 病变。
