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目的:探讨视神经脊髓炎(neuromyelitis optica,NMO)患者视神经的MRI表现特点。方法:对临床疑似NMO患者进行视神经、脑部和脊髓扫描,将满足NMO最新Wingerchuk诊断标准的41例患者纳为研究对象,进行随访研究,分析不同病程阶段视神经MRI表现特点,并与32位健康志愿者进行对照。同时,回顾性分析患者视神经诱发电位(visual evoked poten-tial,VEP)检查结果,探讨MRI表现与VEP之间的关系。结果:正常志愿者MRI显示双侧视神经走行笔直,部分节段视神经鞘膜腔表现为稍高信号,但“双轨样”改变不明显。而NMO患者最常见的异常改变为视神经鞘膜腔信号显著增高,呈全程连续性“双轨样”改变,较健康志愿者明显不同。急性期,22例患者(53.7%)伴有视神经增粗或(和)扭曲;17例(41.5%)可见视神经内点状高信号表现;31例(75.6%)在横断位T1WI上可见到视神经强化。缓解期,15例(36.6%)MRI上可见单侧或双侧视神经萎缩、变细和(或)扭曲。在本组研究结束时,共35例(80.5%)视神经内见点状高信号表现。对照VEP检查结果,MRI在反映视神经脱髓鞘改变上,敏感性为94.6%,但在急性期仅为43.6%,说明MRI检查具有一定的时间依赖性,不及VEP敏感。结论:MRI能清晰显示NMO患者各个病理阶段视神经的形态改变,MRI可以成为视神经的首选影像学检查方法。
Objective: To investigate the MRI manifestations of optic nerve in patients with neuromyelitis optica (NMO). Methods: The optic nerve, brain and spinal cord were scanned in patients with suspected NMO. The 41 patients meeting the diagnostic criteria of NMO latest Wingerchuk were enrolled in the study. Follow-up studies were performed to analyze MRI manifestations of optic nerve at different stages of disease and were compared with 32 healthy Volunteers to control. At the same time, retrospective analysis of visual evoked potential (VEP) test results to explore the relationship between MRI performance and VEP. Results: The normal volunteers MRI showed that the bilateral optic nerve went straight and some optic nerve sheath showed slightly higher signal, but the change of “double track” was not obvious. The most common abnormal changes in patients with NMO optic nerve sheath signal was significantly increased, showing a continuous “double track” changes, significantly different from healthy volunteers. In the acute phase, optic nerve thickening or (or) distorting was found in 22 patients (53.7%), and vertex-like high signal in 17 cases (41.5%). Optic nerve was seen in T1WI in 31 cases (75.6% strengthen. During remission, unilateral or bilateral optic nerve atrophy, thinning and / or distorting were seen on MRI in 15 cases (36.6%). At the end of this study, a total of 35 patients (80.5%) showed punctate high signal within the optic nerve. According to the results of VEP examination, MRI showed 94.6% sensitivity in demyelination of optic nerve, but only 43.6% in acute phase, indicating that MRI has certain time-dependent and less sensitive than VEP. Conclusion: MRI can clearly show the morphological changes of optic nerve in all pathological stages of NMO patients. MRI can be the first imaging method of optic nerve.