Kuwabara S, Nakajima M, Matsuda S, Hattori T
Department of Neurology, School of Medicine, Chiba University, Japan.
Neurology. 1997 Apr;48(4):874-7. doi: 10.1212/wnl.48.4.874.
Using MRI, we investigated the morphology and blood-nerve barrier function of the peripheral nerve trunk in 10 patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Eight patients had a focal demyelinative segment in the median or ulnar nerve trunk that was defined by conduction block or abnormal temporal dispersion over a short distance. These demyelinative foci showed nerve enlargement with high signal intensity on proton or T2-weighted images. In four patients with progressive illness or relapse, the enlarged segment showed gadolinium enhancement that disappeared during remission induced by immune therapies. The other four were in the steady phase and showed no gadolinium enhancement of the enlarged nerves. The two patients who showed conduction slowing, but no focal demyelinative focus, had neither nerve enlargement nor gadolinium enhancement. In CIDP, focal conduction abnormalities correlate well with anatomic changes that suggest intermittent, repeated inflammation associated with the breakdown of the blood-nerve barrier.
我们利用磁共振成像（MRI）对10例慢性炎症性脱髓鞘性多发性神经病（CIDP）患者的周围神经干形态及血神经屏障功能进行了研究。8例患者的正中神经或尺神经干存在局灶性脱髓鞘节段，其通过传导阻滞或短距离内异常的时间离散来定义。这些脱髓鞘病灶在质子或T2加权图像上表现为神经增粗及高信号强度。在4例病情进展或复发的患者中，增粗节段出现钆增强，在免疫治疗诱导的缓解期消失。另外4例处于稳定期，增粗神经未显示钆增强。2例表现为传导减慢但无局灶性脱髓鞘病灶的患者，神经既无增粗也无钆增强。在CIDP中，局灶性传导异常与解剖学改变密切相关，提示存在与血神经屏障破坏相关的间歇性、反复性炎症。
