medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.medvis-21Research ArticleГОЛОВА И ШЕЯHEAD AND NECKМРТ в диагностике рассеянного склерозаMagnetic Resonance Imaging in Multiple SclerosisБрюховВасилий ВалерьевичBryukhovVasiliy Valerevichnoemail@neicon.ruКуликоваСофья НиколаевнаKulikovaSofya Nikolaevnakulikovasn@gmail.comКротенковаИрина АндреевнаKrotenkovaIrina Andreevnanoemail@neicon.ruКротенковаМарина ВикторовнаKrotenkovaMarina Viktorovnanoemail@neicon.ruПереседоваАнастасия ВячеславовнаPeresedovaAnastasia Vyacheslavovnanoemail@neicon.ruФГБУ “Научный центр неврологии” РАМНРоссияResearch Center of neurology RAMSRussian Federation201428042014021021Copyright © Брюхов В.В., Куликова С.Н., Кротенкова И.А., Кротенкова М.В., Переседова А.В., 20142014Брюхов В.В., Куликова С.Н., Кротенкова И.А., Кротенкова М.В., Переседова А.В.Bryukhov V.V., Kulikova S.N., Krotenkova I.A., Krotenkova M.V., Peresedova A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/21

Основным инструментальным методом диагностики и дифференциальной диагностики рассеянного склероза (РС) является МРТ В работе освещаются основные сигнальные характеристики изменений вещества головного мозга при РС, их расположение и форма, обсуждается роль контрастных средств в диагностике и мониторинге течения данного заболевания. Так, среди стандартных МРТ-методик T2-FLAIR и Т2-взвешенные изображения (ВИ) являются наиболее чувствительными для обнаружения очагового поражения вещества головного мозга, а Т1ВИ с применением гадолинийсодержащих контрастных веществ - для определения вновь появившихся или реактивировавшихся очагов демиелинизации. Для подтверждения диагноза РС необходимо наличие соответствия нейровизуализационных данных двум ключевым характеристикам: диссеминации очагового поражения вещества головного мозга в пространстве и во времени, которые лежат в основе МРТ-критериев McDonald в пересмотре от 2005 и 2010 гг. Кроме накапливающих контрастное вещество очагов в режиме Т1 для визуализации активности процесса, большое значение также имеет обнаружение новых или увеличенных очагов на T2-FLAIR и Т2ВИ в динамике. Немаловажным является выявление очагов демиелинизации в спинном мозге, которое наблюдается у большинства пациентов с РС. По данным МРТ, кроме того, выделяют редкие атипичные формы РС, такие как диффузный периаксиальный энцефалит Шильдера, концентрический склероз Бало, болезнь Марбурга, и псевдотуморозную форму РС, которые также имеют собственные нейровизуализационные признаки, позволяющие дифференцировать их с классическим вариантом РС и другой патологией центральной нервной системы.

Magnetic resonance imaging (MRI) nowadays is the main diagnostic tool in multiple sclerosis (MS). The article is aimed at reviewing basic signal changes, location and morphology of pathologic lesions in the brain in multiple sclerosis, the role of contrast agents in its diagnostics and monitoring. Among conventional MRI techniques T2-weighted and T2FLAIR-weighted images are the most sensitive for focal damage detection, contrast-enhanced T1-weighted images are still irreplaceable for "active" lesions visualization. Dissemination in space and time is necessary for confirming the diagnosis and forms the basis of McDonald criteria revision of 2005 and 2010. New or enlarged MS lesions on T2 and T2FLAIR images are important for disease activity evaluation together with contrast enhancing T1 lesions. MS lesions detection in the spinal cord is of great importance as it's seen in the majority of patients. MRI also let us identify atypical MS forms like Shilder's diffuse periaxial encephalitis, Balo's concentric sclerosis, Marburg disease and pseudotumorous MS, which are characterized by special neuroimaging signs and thus could be differentiated from classic multiple sclerosis and other central nervous system pathology.

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The authors declare that there are no conflicts of interest present.