MRI在诊断MS的作用2013.ppt

The role of MRI in the diagnosis of Multiple Sclerosis;MS-主要讨论问题;当我们见下面病例，首先考虑是什么病？MS？高血压性小血管病？或其他更少见病？ ;Typical MRI findings in MS;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;characteristic finding multiple hypointense lesions in the corpus callosum;Juxtacortical lesions are specific for MS; ;Common - Juxtacortical lesions ;Juxtacortical lesions（旁正中矢状位更清楚）;Cortical lesions in a patient with relapsing–remitting MS on 3 T MRI ;MS常见病灶-幕下病灶;bright foci in the brainstem and cerebellum;注意MS典型分布;Infratentorial lesions;MS典型灶-脑室周围白质高信号;multiple lesions in a distribution characteristic of MS. ;多发性脊髓灶-MS另一个典型特征;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;T2WI: a 27-year-old woman;非特异深白质灶;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. ;Typical findings a 35-year-old man with relapsing remitting MS;MS切片：perivenous inflammation ;MS斑三种增强类型;;The C-shaped or arclike enhancement, which is fairly characteristic of multiple sclerosis;ring enhancement;女，36岁，双下肢麻木7月，无力4月;MS Variants and Differential diagnosis;A 39 year old male presented with subacute onset of hemianopsia.He was referred for biopsy to differentiate between a glioma or demyelination;Tumefactive MS特征;Balo’s Concentric Sclerosis;Neuromyelitis Optica;Acute Disseminated Encephalomyelitis (ADEM);Here another case of ADEM.;Here another case of ADEM;模糊;The McDonald criteria for MS;Poser- Diagnosis conclusions;2001提出McDonald标准，用MRI代替原Poser标准，在2005，2010修改;Diagnosis;2010年5月在爱尔兰都柏林，国际MS诊断小组第三次会晤（2011简化版）;dissemination in place;4条中有3条才能诊断;≥1 T2灶 至少2区域 不需增强;For dissemination in space (DIS) lesions in two out of four typical areas of the CNS are required;For dissemination in time (DIT) there are two possibilities:;Dawson finger：与脑室垂直卵形灶，是与脑室表面垂直的穿透小静脉周围炎症引起;增???的意义 ;Periventricular, callosal /subcallosal, and ovoid lesions;