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目的 探讨多系统萎缩(MSA)的临床特点、影像学特征与临床表现的相关性,为临床诊断提供依据。方法 按Gilman诊断标准,回顾性分析26例MSA病人临床资料、一般辅助检查结果及脑CT、MRI资料。结果 拟诊MSA 21例,可能MSA 5例,其巾橄榄桥脑小脑萎缩(OPCA)14例,Shy-Drager综合征(SDS)8例,纹状体黑质变性(SND)4例。MRI显示OPCA的主要病变部位在小脑、桥脑、延髓;SDS仅部分有小脑病变,大部分正常;SND主要病变在壳核,而小脑、桥脑、延髓病变不明显。脑CT改变均不明显。结论 临床表现与MRI结合可提高MSA中OPCA、SND的诊断率,在SDS病人MRI改变不明显。一般辅助检查、脑CT对MSA诊断意义不大。
Objective To investigate the clinical features, imaging features and clinical manifestations of multiple system atrophy (MSA) and provide the basis for clinical diagnosis. Methods According to the Gilman diagnostic criteria, clinical data, general auxiliary findings and brain CT and MRI data of 26 MSA patients were retrospectively analyzed. Results Totally 21 MSA were diagnosed, 5 of whom were suspected of having MSA. There were 14 cases of cerebellar atrophy (OPCA), 8 cases of Shy-Drager syndrome (SDS) and 4 cases of substantia nigra degeneration (SND). MRI showed that the main lesions of OPCA were in the cerebellum, pontine and medulla oblongata; SDS only partially had cerebellar lesions, most of them were normal; the main lesions of SND were in putamen, while cerebellar, pons and bulbar lesions were insignificant. Brain CT changes are not obvious. Conclusion The clinical manifestations combined with MRI can improve the diagnostic rate of OPCA and SND in MSA, but not obvious in SDS patients. General auxiliary examination, brain CT diagnosis of MSA little significance.