多发性硬化的MRI诊断2011.2.23.ppt

MultipleSclerosisMRDiagnosis多发性硬化的MRI诊断，overview，multiplesclerosis(ms)isacentralnervoussystemdemyelinatingdiseases多发性sclerosis，MS)是中枢神经系统脱髓鞘病young，middle-aged common.qing，中年，widelydissemidefinedlesionsofclinicalfeature，young临床表现为病变广泛扩散，缓解疾病中复发的神经系统损伤症状diseases diseasionsinthebrainorspinalcid。这种病的病变位于大脑或脊髓，Generatdinthecentralnervoussystembecaethesizesoft thesymptomscausedmssivelossofmyelinsheath因中枢神经系统中大小不同的巨大髓鞘丢失而症状这些硬盘块可以有多个，随着时间的推移，新的硬盘块也可以出现，被称为“多发性”。causeofdisease、virus infection 3360 suchasherpesvirus(chicken pox、simple、simple chicken pox)、means virus、自身免疫反应：被认为是t细胞介导的自身免疫疾病。genetic factors : thereis acertaindegreeofmilial aggregationtendency遗传因素：某种程度的家庭聚集倾向environmental factors : climateiscsold-reenvironmental factors : climateiscsoldinthiswayonaeafteranother、orcontinutetdeeriorate、andfinallymakeswalwingdifficult。disablendbeddden出现各种症状后再次消失。依次恶化，最终吞咽困难，致残，卧床，Treatment，nonspecificdrgtreatmentofthisdisdisease是治疗这种疾病的特殊治疗剂corticosteroidsorimmunounosorpresseasemsorvascularisease？多发性脑白质病变是MS还是血管性病变？mostincidentallyfoundwmlswilhavasculparain。大部分脑白质病变源于血管病变。thelistofpossiblediagnosisofwmlsislong。引起脑白质病变的疾病很多。accordingtotheMcDonaldcriteriaforMS、thediagnasrequireschobjectiveevidescoflesionsdissemidefinedmeandspace。根据ms的McDonald标准，诊断这种疾病需要在时间和空间上对病变传播进行客观证据。mshaatypicaldistributionofwmls(see table)。多发性硬化有典型的分布区域(如表)。多发性硬化症，typicalcformsiinvoicementforpuscallosum胼胝体，UfibersU纤维，Temporallobes颞叶，brainstem脑干小血管疾病也包括脑干，但通常是对称性和中央疾病，ms病变在周围。，心白质(黄色箭头)的非特异性病变可能出现在多种疾病中。typicalcformsinthiscasesis :invlvementfthetemporallobe颞叶(red arrow) juxtacorticallesions(绿色箭头)-toou-fibersarenootinvoldvedinpatient hyperthreads高血压患者(yellowarrow)、thepatienttontheleftnotonlyhassmultipleperiventricus颞叶重复也是MS的特定病变：inhyperensiveencephalopathy、thewmlsarelocteinthefrontalandparietfallobes、uncommonlyintitallobesandnotinthebes在高血压脑病中，脑白质病变位于前额叶和前额叶，而不是颞叶，枕叶很少见。typicalfindingsformsasinaninessyscaseare :multiplelesionsaddjacenttotheventricles(red arrow)。o void卵形lesionsperpendicular垂直totheventricles (yellow arrow)。多multiplelesionsinbrainstem脑干和andcerebellum小脑，theseovoidlesionsarealsocelldawsonfingers。这种卵形病变也称为道森指。theyrepresentareasonofdemyelinationalongthesmallcerebralveinsthatrunperpendiculatotheventricles。这种卵形病变表示沿着大脑的小静脉脱髓鞘，垂直于脑室。therearemultipellesionsinthespinalcord脊髓。bythewaydidyounoticethelesioninthebrainstem脑干？Aspinalcordlesion脊髓togetherwithnalection intrhebellum小脑或orbrainstem脑干isverysuggestieofms，spinalcordlesionsareuncommonostotms脊髓病变在中枢神经系统疾病中不常见，除了脑脊髓炎、结节病、莱姆病、系统性红斑狼疮。left : typicaldawsonfingerwithout hancemenont 1 wi right : multiplexisionsandedma水肿aroundenhancinglionont2 wi。enhancementsisanothertypicalfindinginms . thisenhancementconwill bepresntforaboutonemonthaftertheoccurencecoles . thesimultaneeoonsTheedema水肿willregress下降andfinalyon lythecenterwilremainashyperintensionont 2wi。Ontheleftapatienttwhowashere-examined 3 monthsafterthefirstclinicalattack。3个月后如图，typicalfindingsformsastinthiscaseare :多层次增强功能manyoft heselesis“touch thectoex皮层”and mususthese enhancecing Lesionsallarenewlesions，sincegadollainiumenhancemenisonlyvisibleforabout 1 month . sothisfindisproof ofdisses证明Left : singlelesionont 2 wi . right : twnewlesionsat 3 month follow up，differential diagnsis，Borderzoneinfarction边界区域梗塞key fey，ADEM脑脊髓炎key Keyfindings:Multifocal多lesionsinWM白andbasalganglia基底核10-14daysfollowinginfection感染或vaccine免疫。AsinMS、ADEMcaninvolvethespinalcord、U-fibersandcorpuscallosum语料库allosum andsomesetimesshowenhancement . differentfromment，Lyme莱姆病2-3mmlesionssimulating样MSinapatientwithskinrash皮疹和influenz-like illness流感样患者。otherfindingsarehighsignalingspinalcordandenhancemenofcn 7(根en Try tryzone)。Typicalskinrash皮疹causedb