Thielen K R, Miller G M
Department of Diagnostic Radiology, Mayo Clinic, MN 55905, USA.
J Comput Assist Tomogr. 1996 May-Jun;20(3):434-8. doi: 10.1097/00004728-199605000-00022.
To determine the MR appearance of spinal cord multiple sclerosis (MS) plaques in patients presenting with myelopathy by using a high-field (1.5 T) imager.
We studied 119 patients who underwent high-field (1.5 T) MR studies of the spinal cord for evaluation of myelopathy. All 119 patients were thought to have possible findings of spinal cord MS at the time of the MRI interpretation.
Sixty-four plaques were studied in 47 patients with clinically definite MS and adequate quality MRI. Of these patients 68% had a single spinal cord plaque, 19% had two plaques, and 13% had three or more plaques. Sixty-two percent of the plaques occurred in the cervical spinal cord and most frequently involved the posterior (41%) and lateral (25%) aspects of the spinal cord. None of the 64 lesions involved the entire thickness of the spinal cord. The lesion length varied from 2 to 60 mm, with 84% of the lesions < 15 mm in length. The spinal cord diameter was unchanged in 84% of plaques, enlarged at the level of the lesion in 14%, and atrophic in 2%. Just over half (55%) of the plaques enhanced with intravenously administered gadolinium. Of the patients who received synchronous head and spinal cord examinations on the same day, 24% had normal findings on the MR study of the head. Follow-up spinal cord studies were available in nine patients. New lesions developed in two patients, while previously described lesions resolved. In three patients only new lesions developed. In four patients no change occurred in the existing number of cord plaques.
Spinal cord demyelinating plaques present as well-circumscribed foci of increased T2 signal that asymmetrically involve the spinal cord parenchyma. Knowledge of their usual appearance may prevent unnecessary biopsy. An MR examination of the head may confirm the imaging suggestion of spinal cord demyelinating disease, because up to 76% of patients have abnormal intracranial findings. In the remaining 24% of cases in which the clinical diagnosis is not certain and MR findings in the head are negative, a follow-up spinal cord study is recommended, because these lesions evolve and change over time.
使用高场强（1.5T）成像仪确定脊髓型多发性硬化（MS）患者脊髓斑块的磁共振成像（MR）表现。
我们研究了119例因脊髓病接受脊髓高场强（1.5T）MR检查的患者。在MRI解读时，所有119例患者均被认为可能有脊髓MS的表现。
对47例临床确诊为MS且MRI质量合格的患者的64个斑块进行了研究。这些患者中，68%有单个脊髓斑块，19%有两个斑块，13%有三个或更多斑块。62%的斑块位于颈髓，最常累及脊髓的后部（41%）和外侧（25%）。64个病变均未累及脊髓全层。病变长度从2至60mm不等，84%的病变长度<15mm。84%的斑块处脊髓直径无变化，14%在病变水平处脊髓增粗，2%脊髓萎缩。略超过一半（55%）的斑块在静脉注射钆剂后强化。在同一天接受头颅和脊髓同步检查的患者中，24%的头颅MR检查结果正常。9例患者有脊髓随访研究。2例患者出现新病变，而之前描述的病变消失。3例患者仅出现新病变。4例患者脊髓斑块数量无变化。
脊髓脱髓鞘斑块表现为T2信号增高的边界清晰的病灶，不对称地累及脊髓实质。了解其常见表现可避免不必要的活检。头颅MR检查可证实脊髓脱髓鞘疾病的影像学提示，因为高达76%的患者有颅内异常表现。在其余24%临床诊断不明确且头颅MR检查结果为阴性的病例中，建议进行脊髓随访研究，因为这些病变会随时间演变和变化。
