Thorpe J W, Kidd D, Moseley I F, Thompson A J, MacManus D G, Compston D A, McDonald W I, Miller D H
NMR Research Unit, Institute of Neurology, London, UK.
Brain. 1996 Jun;119 ( Pt 3):709-14. doi: 10.1093/brain/119.3.709.
Although MRI detects the white matter lesions of multiple sclerosis within the brain with high sensitivity, a minority of patients have normal brain MRI. We describe 20 patients, selected from over 170 who had undergone brain imaging with minimal (n = 12) or no (n = 8) abnormalities (median number of lesions = I, range, 0-3) but in whom spinal MRI was abnormal. Twelve had clinically definite or laboratory supported definite multiple sclerosis according to the Poser criteria; one had clinically probable disease and seven, not fulfilling the Poser criteria, were classified as possible multiple sclerosis. All had presented with symptoms and signs referable to the spinal cord or optic nerves. Eleven had a primary progressive course, eight relapsing-remitting and only one secondary progressive. Moderate or severe disability was the rule in the primary progressive cases; all the relapsing-remitting patients had minimal disability. All had at least one lesion visible in the spinal cord (median 2; range 1-6). In patients in whom the diagnosis of multiple sclerosis is not supported by abnormalities on brain MRI, imaging of the spinal cord can be of considerable value.
尽管磁共振成像（MRI）对检测脑内多发性硬化的白质病变具有高敏感性，但仍有少数患者的脑部MRI检查结果正常。我们描述了20例患者，这些患者是从170余例接受脑部成像检查的患者中挑选出来的，他们的脑部成像结果仅有轻微异常（n = 12）或无异常（n = 8）（病灶中位数为1，范围为0 - 3），但脊髓MRI检查结果异常。根据波泽（Poser）标准，其中12例患者患有临床确诊或实验室支持确诊的多发性硬化；1例患者患有临床可能的疾病，另外7例不符合波泽标准，被归类为可能的多发性硬化。所有患者均出现了与脊髓或视神经相关的症状和体征。11例患者病程为原发进展型，8例为复发缓解型，仅1例为继发进展型。原发进展型病例通常存在中度或重度残疾；所有复发缓解型患者的残疾程度均较轻。所有患者的脊髓至少有一个可见病灶（中位数为2；范围为1 - 6）。对于脑部MRI检查结果未显示异常而无法支持多发性硬化诊断的患者，脊髓成像可能具有重要价值。
