| 척수 자기공명영상을 통한 특발성 급성 횡단성
척수증과 척수 다발성 경화증의 감별 |
| 김호진, 장기현*·김성훈 ·김광기 ·이용석 ·이광우 |
| 서울대학교 의과대학 신경과학교실,방사선과학교실* |
| Differentiation between Idiopathic Acute Transverse Myelitis
and Myelopathic Multiple Sclerosis by MRI |
| Ho Jin Kim, M.D., Kee Hyun Chang, M.D.*, Sung Hun Kim, M.D.,
Kwang-Ki Kim, M.D., Yong-Seok Lee, M.D., Kwang-Woo Lee, M.D. |
| Department of Neurology & Radiology*, College of Medicine, Seoul National University |
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| Abstract |
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Background : Idiopathic acute transverse myelitis (ATM) is an inflammatory or demyelinating illness of unknown
etiology. It is usually monophasic, though recurrences at the same spinal level of the initial attack have been reported.
In Korea, the spinal cord is the most commonly affected site of multiple sclerosis (MS) and its clinical features often
resemble those of ATM. As the prognoses of these two conditions are different, it is important to distinguish them from
each other. The purpose of this study was to evaluate spinal MRI findings that could help differentiate ATM from
myelopathic MS. M e t h o d s : A total of 50 MRIs obtained less than four weeks after the onset of symptoms in 13
patients with ATM and 24 patients with clinically definite MS were reviewed retrospectively. The diagnostic criterion
for ATM was a rapid onset of spinal motor and sensory dysfunction referable to a distinct spinal cord level with sphinc-ter
dysfunction, reaching its peak within 4 weeks, in the absence of pre-existing neurological diseases and spinal cord
compression. For MS, Poser’s criteria were used. We analyzed the lesion length, location, cross-sectional area, cord
morphology, and contrast enhancement patterns in each of the groups. Results : Characteristic MRI findings of ATM
included; 1) centrally located hyperintensity (86%) occupying more than half of the cross-sectional area of the cord
(100%), 2) thoracic preponderance in lesion location (thoracic: 7, cervicothoracic:3, cervical: 1), 3) lesion length of
more than 3 vertebral segments (100%), 4) cord swelling (73%), and 5) focal or diffuse enhancement (90%). Most MRI
findings of myelopathic MS (MMS) were not different from those of ATM, especially in Asian-type MS. Different
MRI features of MMS from those of ATM included: 1) peripherally located hyperintensity occupying less than half of
the cross-sectional area of the cord (20.8%), 2) lesion length less than two vertebral segments (33.3%), 3) normal cord
morphology (25%), 4) no enhancement (36.1%), and 5) multifocality (22.2%), which were more commonly found in
Western-type MS. C o n c l u s I o n s : Although there were some differences of spinal MRI features between ATM and
MMS, it was not easy to differentiate them by MRI findings alone. The findings suggest that Asian-type MS has unique
MRI characteristics similar to those of ATM and different from those of Western-type MS.
J Kor Neurol Ass 17(5):651~660, 1999
Key Words : Acute transverse myelitis, Multiple sclerosis, Spinal cord, MRI |
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