MRI在诊断MS的作用2013PPT课件
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同时有2类病灶
近皮质灶难以与长T2 皮质区别，放大更清楚
.
8
Common - Juxtacortical lesions
.
9
Common - Juxtacortical lesions
Juxtacortical lesions（旁正中矢状位更清楚）
.
10
sometimes - Cortical lesions
The role of MRI in the diagnosis of Multiple Sclerosis
http://www.radiologyassistant.nl/en/p4556dea65db62/multiple-sclerosis.html
.
Publication date May , 2013
2001提出McDonald标准，用MRI代替 原Poser标准，在2005，2010修改
2010年5月在爱尔兰都柏林，国际M.S诊断小组第三次会晤（2011简化版）42
Diagnosis
• 2010年5月，一个国际专家小组在爱尔兰都柏林修订 McDonald criteria， – 简化病灶空间和时间弥散标准，并在某些情况下，仅 一次扫描就可以确定 – 随着时间的推移，如果MRI显示新病灶形成，容许 MRI参与诊断，使尽早些诊断成为可能 – 即使有了这些进展，由于MS的复杂性和变异，仍然 有些患者多年诊断不确定
lesions may sometimes mimic brain tumors because of the
associated edema and inflammation.
.
24
typical – Dawson fingers
MS切片：perivenous inflammation
小静脉
Lymphocytic infiltration
involvement of U-fibers in MS Hypertension- U-fibers are not involved
与皮质 接触
高信号白质病 变与皮层间
有暗带
”特异性差
T2
Juxtacortica lesions
subcortical lesion-a larger
adjacent to the cortex and must touch the cortex
– Laboratory supported probable MS. Only two attacks is enough to enter this category
– No MS – There is no clinical evicence of having MS.
Poser CM,, et al. "New diagnostic criteria for multiple sclerosis: Guidelines for research protocols". Ann.als of Neurology 1983 13 (3): 227–31.41
.
17
typical – Spinal cord
PDWI:显示MS脊髓最佳序列：脊髓均匀低信号，MS斑反差强更清楚 a patient with MS
多发性脊髓灶-MS另一个典型特征
SE PDW
相对小，周围性，好发颈髓，小于2节段
病灶同时见于脊髓，小脑或 脑干高度提示MS！
脊髓病灶很少见于其他CNS病，除了ADEM, Sarcoid, Lyme和 SLE
.
5
Common -corpus callosum
characteristic finding multiple hypointense lesions in the corpus
callosum
T1WI
.
6
Common - Juxtacortical lesions
Juxtacortical lesions are specific for MS
Tumefactive MS.
灶周水肿 占位征相对轻
T2W
增强
T2WI低信号环
活检处
右颞枕瘤样脱髓鞘. 病，活检证实
周围部分增强 (不完全环）
an incomplete ring
32
Differential diagnosis
Balo’s Concentric Sclerosis
少见脱髓鞘病，脱髓鞘灶和髓鞘呈带状交替出现,螺纹样
1
MS-主要讨论问题
• 典型MRI发现 • McDonald标准：MRI在诊断的应用 • 鉴别诊断： MS-其他常见白质病变
.
2
Typical MRI findings in MS
.
4
Common -corpus callosum
多发性硬化特征性发现
胼胝体病灶和胼胝体周围白质病灶
PDWI
T2WI
– Laboratory supported definite MS, showing oligoclonal bands and clinical or paraclinical evidences
– Clinically probable MS, with less restrict combinations.
.
hemicord
20
typical – Dawson fingers
Dawson fingers
.
22
typical – Dawson fingers
• Dawson fingers are a radiographic feature depicting demyelinating plaques through corpus callosum, arranged at right angles along medullary veins (callososeptal location)
• They are a relatively specific sign for MS, which presents as T2 hyperintensities.
.
23
typical – Dawson fingers
Typical findings
a 35-year-old man with relapsing remitting MS
注意MS典型分 布
卵圆形垂直灶
脑干和小脑多发灶
多灶邻近脑室
常见幕下病灶
.
14
typical - infratentorial lesions
Infratentorial lesions
T2
增强
两个病灶，一个增强
桥脑左侧，右中脑角
.
仅仅左侧病灶增强
dissemination in time
15
typical - periventricular lesions
Acute Disseminated Encephalomyelitis (ADEM)
特征性丘脑灶 不会发生在MS
广泛皮层灰. 质受累
选择性累及皮质， 基底节和丘脑
36
Differential diagnosis
Here another case of ADEM.
注意基底节受累
未增强
可以增强
.
小脑
MS传统认为是白质病变，近年来超高. 场MRI清晰显示大脑灰质也存在病灶11
typical - infratentorial lesions
MS常见病灶-幕下病灶
.
12
typical - infratentorial lesions
bright foci in the brainstem and cerebellum
a fusiform area of increased signal intensity representing a MS plaque
axial : a multiple sclerosis
plaque located in the left
dorsolateral region of the left
area of white matter almost reaching the ventricles
.
7
Common - Juxtacortical lesions
特征性MS灶：Juxtacortical MS lesion located in the U-fiber
近皮质灶
脑室周多发灶，含 Dawson finger(箭）
Cortical lesions in a patient with relapsing– remitting MS on 3 T MRI
3D double-inversion recovery
cross-referenced 3D T1WI
3D FLAIR
皮质2个高信号灶
相应区域低信号
注意：常规序列无法 显示这些皮质灶
• Ovoid lesions perpendicular to the
ventricles surface are common
MRI reveals multiple lesions with high T2 signal intensity
and one large white matter lesion. These demyelinating
PDWI
Specifically, the
periventricular
lesions and the
more peripheral
white matter
lesions near the
gray matter–
white matter
junction are
typical MRI
findings in MS
MS典型灶-脑室周围白质高信号
FLAIR
a highly sensitive sequence for lesion detection, particularly supratentorially
.
16
typical - periventricular lesions
multiple lesions in a distribution characteristic of MS.
左侧巨大灶 T2高/等信号
交替出现
交替性线性增强
右侧较小类似灶
.
34
Differential diagnosis
Neuromyelitis Optica
单侧视神经炎
脊髓肿，病变广 (3节以上)
横切累及 大部脊髓
诊断线索是AQP4-抗体滴度是1:1024 .
大脑少数 T2病灶
35
Differential diagnosis
.
18
typical – Spinal cord
典型病史
24岁,单眼视力↓→数年后四肢运动感觉损害 →双下肢感觉损害就诊→MS可能
边界清楚
边界模糊
横切-背部典型三角形
无增强效应
.
脊髓活动灶可增强,但远不如脑常见19
typical – Spinal cord
T2WI: a 27-year-old woman
淋巴细胞浸润见于小静脉周围，这些淋巴细胞攻击髓鞘
MS病变始于静脉周围炎症，在前4周内
BBB受损→初期均匀增强，可以变为环型
增强
.
25
solid enhancement,
.
27
arclike enhancement
The C-shaped or arclike enhancement, which is fairly characteristic of multiple sclerosis
37
McDonald criteria
The McDonald criteria for MS
.
40
Poser- Diagnosis conclusions
• The criteria can yield five conclusions:
– Clinically definite MS. Needs two attacks and some clinical or paraclinical evidences
PDWI: highly sensitive for the detection of plaques in MS, especially in the posterior fossa
.
13
typical - infratentorial lesions
Multiple WMLs with a typical distribution for MS
右颞枕增强斑
.
28
ring enhancement
.
29
MS Variants
A 39 year old male presented with subacute onset of hemianopsia. He was referred for biopsy to differentiate between a glioma or demyelination
近皮质灶难以与长T2 皮质区别，放大更清楚
.
8
Common - Juxtacortical lesions
.
9
Common - Juxtacortical lesions
Juxtacortical lesions（旁正中矢状位更清楚）
.
10
sometimes - Cortical lesions
The role of MRI in the diagnosis of Multiple Sclerosis
http://www.radiologyassistant.nl/en/p4556dea65db62/multiple-sclerosis.html
.
Publication date May , 2013
2001提出McDonald标准，用MRI代替 原Poser标准，在2005，2010修改
2010年5月在爱尔兰都柏林，国际M.S诊断小组第三次会晤（2011简化版）42
Diagnosis
• 2010年5月，一个国际专家小组在爱尔兰都柏林修订 McDonald criteria， – 简化病灶空间和时间弥散标准，并在某些情况下，仅 一次扫描就可以确定 – 随着时间的推移，如果MRI显示新病灶形成，容许 MRI参与诊断，使尽早些诊断成为可能 – 即使有了这些进展，由于MS的复杂性和变异，仍然 有些患者多年诊断不确定
lesions may sometimes mimic brain tumors because of the
associated edema and inflammation.
.
24
typical – Dawson fingers
MS切片：perivenous inflammation
小静脉
Lymphocytic infiltration
involvement of U-fibers in MS Hypertension- U-fibers are not involved
与皮质 接触
高信号白质病 变与皮层间
有暗带
”特异性差
T2
Juxtacortica lesions
subcortical lesion-a larger
adjacent to the cortex and must touch the cortex
– Laboratory supported probable MS. Only two attacks is enough to enter this category
– No MS – There is no clinical evicence of having MS.
Poser CM,, et al. "New diagnostic criteria for multiple sclerosis: Guidelines for research protocols". Ann.als of Neurology 1983 13 (3): 227–31.41
.
17
typical – Spinal cord
PDWI:显示MS脊髓最佳序列：脊髓均匀低信号，MS斑反差强更清楚 a patient with MS
多发性脊髓灶-MS另一个典型特征
SE PDW
相对小，周围性，好发颈髓，小于2节段
病灶同时见于脊髓，小脑或 脑干高度提示MS！
脊髓病灶很少见于其他CNS病，除了ADEM, Sarcoid, Lyme和 SLE
.
5
Common -corpus callosum
characteristic finding multiple hypointense lesions in the corpus
callosum
T1WI
.
6
Common - Juxtacortical lesions
Juxtacortical lesions are specific for MS
Tumefactive MS.
灶周水肿 占位征相对轻
T2W
增强
T2WI低信号环
活检处
右颞枕瘤样脱髓鞘. 病，活检证实
周围部分增强 (不完全环）
an incomplete ring
32
Differential diagnosis
Balo’s Concentric Sclerosis
少见脱髓鞘病，脱髓鞘灶和髓鞘呈带状交替出现,螺纹样
1
MS-主要讨论问题
• 典型MRI发现 • McDonald标准：MRI在诊断的应用 • 鉴别诊断： MS-其他常见白质病变
.
2
Typical MRI findings in MS
.
4
Common -corpus callosum
多发性硬化特征性发现
胼胝体病灶和胼胝体周围白质病灶
PDWI
T2WI
– Laboratory supported definite MS, showing oligoclonal bands and clinical or paraclinical evidences
– Clinically probable MS, with less restrict combinations.
.
hemicord
20
typical – Dawson fingers
Dawson fingers
.
22
typical – Dawson fingers
• Dawson fingers are a radiographic feature depicting demyelinating plaques through corpus callosum, arranged at right angles along medullary veins (callososeptal location)
• They are a relatively specific sign for MS, which presents as T2 hyperintensities.
.
23
typical – Dawson fingers
Typical findings
a 35-year-old man with relapsing remitting MS
注意MS典型分 布
卵圆形垂直灶
脑干和小脑多发灶
多灶邻近脑室
常见幕下病灶
.
14
typical - infratentorial lesions
Infratentorial lesions
T2
增强
两个病灶，一个增强
桥脑左侧，右中脑角
.
仅仅左侧病灶增强
dissemination in time
15
typical - periventricular lesions
Acute Disseminated Encephalomyelitis (ADEM)
特征性丘脑灶 不会发生在MS
广泛皮层灰. 质受累
选择性累及皮质， 基底节和丘脑
36
Differential diagnosis
Here another case of ADEM.
注意基底节受累
未增强
可以增强
.
小脑
MS传统认为是白质病变，近年来超高. 场MRI清晰显示大脑灰质也存在病灶11
typical - infratentorial lesions
MS常见病灶-幕下病灶
.
12
typical - infratentorial lesions
bright foci in the brainstem and cerebellum
a fusiform area of increased signal intensity representing a MS plaque
axial : a multiple sclerosis
plaque located in the left
dorsolateral region of the left
area of white matter almost reaching the ventricles
.
7
Common - Juxtacortical lesions
特征性MS灶：Juxtacortical MS lesion located in the U-fiber
近皮质灶
脑室周多发灶，含 Dawson finger(箭）
Cortical lesions in a patient with relapsing– remitting MS on 3 T MRI
3D double-inversion recovery
cross-referenced 3D T1WI
3D FLAIR
皮质2个高信号灶
相应区域低信号
注意：常规序列无法 显示这些皮质灶
• Ovoid lesions perpendicular to the
ventricles surface are common
MRI reveals multiple lesions with high T2 signal intensity
and one large white matter lesion. These demyelinating
PDWI
Specifically, the
periventricular
lesions and the
more peripheral
white matter
lesions near the
gray matter–
white matter
junction are
typical MRI
findings in MS
MS典型灶-脑室周围白质高信号
FLAIR
a highly sensitive sequence for lesion detection, particularly supratentorially
.
16
typical - periventricular lesions
multiple lesions in a distribution characteristic of MS.
左侧巨大灶 T2高/等信号
交替出现
交替性线性增强
右侧较小类似灶
.
34
Differential diagnosis
Neuromyelitis Optica
单侧视神经炎
脊髓肿，病变广 (3节以上)
横切累及 大部脊髓
诊断线索是AQP4-抗体滴度是1:1024 .
大脑少数 T2病灶
35
Differential diagnosis
.
18
typical – Spinal cord
典型病史
24岁,单眼视力↓→数年后四肢运动感觉损害 →双下肢感觉损害就诊→MS可能
边界清楚
边界模糊
横切-背部典型三角形
无增强效应
.
脊髓活动灶可增强,但远不如脑常见19
typical – Spinal cord
T2WI: a 27-year-old woman
淋巴细胞浸润见于小静脉周围，这些淋巴细胞攻击髓鞘
MS病变始于静脉周围炎症，在前4周内
BBB受损→初期均匀增强，可以变为环型
增强
.
25
solid enhancement,
.
27
arclike enhancement
The C-shaped or arclike enhancement, which is fairly characteristic of multiple sclerosis
37
McDonald criteria
The McDonald criteria for MS
.
40
Poser- Diagnosis conclusions
• The criteria can yield five conclusions:
– Clinically definite MS. Needs two attacks and some clinical or paraclinical evidences
PDWI: highly sensitive for the detection of plaques in MS, especially in the posterior fossa
.
13
typical - infratentorial lesions
Multiple WMLs with a typical distribution for MS
右颞枕增强斑
.
28
ring enhancement
.
29
MS Variants
A 39 year old male presented with subacute onset of hemianopsia. He was referred for biopsy to differentiate between a glioma or demyelination