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由於磁振造影對中樞神經系統的解析度絕佳,目前已被廣為應用在多發性硬化的診斷上。本篇收集了台大醫院自民國79年10月至81年3月共18個月間,接受磁振造影的檢查中其臨床診斷為臨床確定,l生多發,l生硬化(clinically definite multiple sclerosis)共15例。發現磁振造影對臨床確定性多發性硬化的敏感度(sensitivity),高達93%(14/15)。而MRI檢查有斑(plaque)者其分佈在大腦者佔77%(10/13),在後腦窩者佔77%(10/13),在脊髓者佔82%(9/11),但是在視神經上並沒有任何斑的發現(10/13)。值得一提的是9個脊髓MRI為陽性的病人有4個其病灶的長度超過6公分。當將MRI上斑的位置與臨床的症狀及徵象(S/S)做比較時,發現一在大腦部位,MRI比臨床S/S更靈敏,在脊髓部位MRI及臨床S/S有很好的一致性。至於在視神經方面,臨床S/S的靈敏度要大大勝過MRI。有關急性發作病人釓顯影劑(Gd-DTPA)的顯影率,發現55%(6/11)的急性發作病人有Gd-DTPA的顯影。在台灣MS的病人最初或整個病程中以脊髓或視神經症狀最常見。由於眼部MRI的不敏感及脊髓MRI與臨床S/S良好的一致性以及有視神經或脊髓症狀其頭部MRI陽性率高達90%,所以建議在經濟的考慮下,有視神經或脊髓症狀者要確定MS的診斷,頭部MRI為第一選擇。

Parallel abstracts

Magnetic resonance imaging (MRI), the latest test for evaluation of multiple sclerosis (MS), was assessed in 15 cases with clnically definite MS (CDMS) at NUTH from October 1990 to March 1992. MRI was positive in 14 of 15 patients (93%). The frequencies of sites of plaques in MRI were: 77% in the cerebrum, 77% in the posterior fossa, 82% in the spinal cord, and 0% in the optic nerve. It was interesting to find long segment of spinal involvement (>6 cm) in 4 of 9 positive spinal MRI. Comparing clinical symptoms/signs (S/S) and MRI findings, we found that: (1) in the cerebrum, MRI was much more sensitive than clinical S/S; (2) in the spinal cord, clinical S/S had very good concurrent rate with MRI; and (3) in optic nerve, the clinical S/S was much more accurate than routine brain MRI. Enhancement of Gd-DTPA was found in only 6 (55%) of 11 patients with acute exacerbating MS. In Taiwan, optic and spinal cord S/S were most frequently seen in the course of MS. We suggest head MRI as the first choice test for those suspected MS patients, since (1) poor orbit MRI sensitivity and good spinal cord clinical-MR concurrent rate render MRI of orbit and spinal cord less helpful in diagnosing MS. In addition, head MRI has high positive rate (about 90%) in CDMS if patient has optic or spinal cord S/S For economic reason, head MRI should be the first choice for these patients.

Parallel keywords

Sclerosis, multiple Brain, MRI