rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2019-100-4-229-236rentrad-495Research ArticleОБЗОРЫREVIEWSМагнитно-резонансная томография в дифференциальной диагностике рассеянного склероза и других демиелинизирующих заболеванийMagnetic Resonance Imaging in the Differential Diagnosis of Multiple Sclerosis and Other Demyelinating Diseaseshttps://orcid.org/0000-0001-5823-9434КротенковаИ. А.KrotenkovaI. A.

к. м. н., науч. сотр.

Cand. Med. Sc., Researcher

irina.krotenkova@mail.ruhttps://orcid.org/0000-0002-1645-6526БрюховВ. В.BryukhovV. V.

к. м. н., ст. науч. сотр.

Cand. Med. Sc., Senior Researcher

https://orcid.org/0000-0001-5539-245XКоноваловР. Н.KonovalovR. N.

к. м. н., вед. науч. сотр.

Cand. Med. Sc., Leading Researcher

ЗахароваМ. Н.ZakharovaM. N.

д. м. н., руководитель 6-го неврологического отделения

Dr. Med. Sc., Head of 6 Neurology Department

https://orcid.org/0000-0003-3820-4554КротенковаМ. В.KrotenkovaM. V.

д. м. н., руководитель отделения лучевой диагностики

Dr. Med. Sc., Head of Radiology Department

ФГБНУ «Научный центр неврологии»РоссияResearch Center of NeurologyRussian Federation2019090920191004229236Copyright © Кротенкова И.А., Брюхов В.В., Коновалов Р.Н., Захарова М.Н., Кротенкова М.В., 20192019Кротенкова И.А., Брюхов В.В., Коновалов Р.Н., Захарова М.Н., Кротенкова М.В.Krotenkova I.A., Bryukhov V.V., Konovalov R.N., Zakharova M.N., Krotenkova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/495

Диагностика рассеянного склероза (РС) довольно сложна, что связано с особенностями клинической картины и отсутствием уникальных подтверждающих тестов. Магнитно-резонансная томография (МРТ) является одним из способов подтверждения диагноза, кроме того, она позволяет проводить дифференциальную диагностику с другими демиелинизирующими заболеваниями и исключать патологии, имитирующие РС. В настоящем обзоре представлены не только МРТ-критерии РС и других сходных по МРТ-картине заболеваний, но и дополнительные клинические и лабораторные данные, без применения которых невозможна постановка правильного диагноза.

The diagnosis of multiple sclerosis (MS) is quite complicated, which is associated with its clinical features and the lack of unique confirmatory tests. Magnetic resonance imaging (MRI) is one of the ways to confirm the diagnosis and also makes it possible to establish a differential diagnosis with other demyelinating diseases and to exclude diseases that mimic MS. This review presents not only MRI criteria for MS and other diseases similar to the MRI pattern, but also additional clinical and laboratory data, without which it is impossible to make a correct diagnosis.

рассеянный склерозмагнитно-резонансная томографиядифференциальная диагностиканеопухолевые многоочаговые изменения головного мозгаmultiple sclerosismagnetic resonance imagingdifferential diagnosisnon-tumor multifocal changes in the brainИсследование не имело спонсорской поддержки.The study had no sponsorship.ReferencesChen J.J., Carletti F., Young V., Mckean D., Quaghebeur G. MRI differential diagnosis of suspected multiple sclerosis. Clin. Radiol. 2016; 71 (9): 815–27. DOI: 10.1016/j.crad.2016.05.010Chen J.J., Carletti F., Young V., Mckean D., Quaghebeur G. MRI differential diagnosis of suspected multiple sclerosis. Clin. Radiol. 2016; 71 (9): 815–27. DOI: 10.1016/j.crad.2016.05.010Брюхов В.В., Куликова С.Н., Кротенкова И.А., Кротенкова М.В., Переседова А.В. МРТ в диагностике рассеянного склероза. Медицинская визуализация. 2014; 2: 10–21.Bryukhov V.V., Kulikova S.N., Krotenkova I.A., Krotenkova M.V., Peresedova A.V. Magnetic resonance imaging in multiple sclerosis. Medical Visualization. 2014; 2: 10–21 (in Russ.).Кротенкова И.А., Брюхов В.В., Переседова А.В., Кротенкова М.В. Атрофия центральной нервной системы при рассеянном склерозе: данные МРТ-морфометрии. Журнал неврологии и психиатрии им. С.С. Корсакова. 2014; 114 (10-2): 50–6.Krotenkova I.A., Bryukhov V.V., Peresedova A.V., Krotenkova M.V. Atrophy of the central nervous system in multiple sclerosis: MRI-morphometry results. S.S. Korsakov Journal of Neurology and Psychiatry. 2014; 114 (10-2): 50–6 (in Russ.).Thompson A.J., Banwell B.L., Barkhof F., Carroll W.M., Coetzee T., Comi G. et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018; 17(2): 162–73. DOI: 10.1016/S1474-4422(17)30470-2Thompson A.J., Banwell B.L., Barkhof F., Carroll W.M., Coetzee T., Comi G. et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018; 17(2): 162–73. DOI: 10.1016/S1474-4422(17)30470-2Charil A., Yousry T.A., Rovaris M., Barkhof F., De Stefano N., Fazekas F., Filippi M. MRI and the diagnosis of multiple sclerosis: expanding the concept of “no better explanation”. Lancet Neurol. 2006; 5 (10): 841–52. DOI: 10.1016/s1474-4422(06)70572-5Charil A., Yousry T.A., Rovaris M., Barkhof F., De Stefano N., Fazekas F., Filippi M. MRI and the diagnosis of multiple sclerosis: expanding the concept of “no better explanation”. Lancet Neurol. 2006; 5 (10): 841–52. DOI: 10.1016/s1474-4422(06)70572-5Miller D., Weinshenker B., Filippi M., Banwell B., Cohen J., Freedman M., Polman C. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Multiple Scler. J. 2008; 14 (9): 1157–74. DOI: 10.1177/1352458508096878Miller D., Weinshenker B., Filippi M., Banwell B., Cohen J., Freedman M., Polman C. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Multiple Scler. J. 2008; 14 (9): 1157–74. DOI: 10.1177/1352458508096878Solomon A.J., Klein E.P., Bourdette D. “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology. 2012; 78 (24): 1986–91. DOI: 10.1212/ wnl.0b013e318259e1b2Solomon A.J., Klein E.P., Bourdette D. “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology. 2012; 78 (24): 1986–91. DOI: 10.1212/ wnl.0b013e318259e1b2Rovira A`., Wattjes M.P., Tintoré M., Tur C., Yousry T.A., Montalban X. MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis – clinical implementation in the diagnostic process. Nature Rev. Neurol. 2015; 11 (8): 471–82. DOI: 10.1038/nrneurol.2015.106Rovira A`., Wattjes M.P., Tintoré M., Tur C., Yousry T.A., Montalban X. MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis – clinical implementation in the diagnostic process. Nature Rev. Neurol. 2015; 11 (8): 471–82. DOI: 10.1038/nrneurol.2015.106Vogl T.J., Friebe C.E., Balzer T., Mack M.G., Steiner S., Schedel H. et al. Diagnosis of cerebral metastasis with standard dose gadobutrol vs. a high dose protocol. Intraindividual evaluation of a phase II high dose study. Radiologe. 1995;35 (8): 508–16.Vogl T.J., Friebe C.E., Balzer T., Mack M.G., Steiner S., Schedel H. et al. Diagnosis of cerebral metastasis with standard dose gadobutrol vs. a high dose protocol. Intraindividual evaluation of a phase II high dose study. Radiologe. 1995;35 (8): 508–16.Rohrer M., Bauer H., Mintorovitch J., Requardt M., Weinmann H.-J. Comparison of magnetic properties of MRI contrast media solutions at different magnetic field strengths. Invest. Radiol. 2005; 40 (11): 715–24. DOI:10.1097/01.rli.0000184756.66360.d3Rohrer M., Bauer H., Mintorovitch J., Requardt M., Weinmann H.-J. Comparison of magnetic properties of MRI contrast media solutions at different magnetic field strengths. Invest. Radiol. 2005; 40 (11): 715–24. DOI:10.1097/01.rli.0000184756.66360.d3Uysal E., Erturk S.M., Yildirim H., Seleker F., Basak M. Sensitivity of immediate and delayed gadolinium-enhanced MRI after injection of 0.5 M and 1.0 M gadolinium chelates for detecting multiple sclerosis lesions. Am. J. Roentgen.2007; 188 (3): 697–702. DOI: 10.2214/ajr.05.2212Uysal E., Erturk S.M., Yildirim H., Seleker F., Basak M. Sensitivity of immediate and delayed gadolinium-enhanced MRI after injection of 0.5 M and 1.0 M gadolinium chelates for detecting multiple sclerosis lesions. Am. J. Roentgen.2007; 188 (3): 697–702. DOI: 10.2214/ajr.05.2212Benner T., Reimer P., Erb G., Schuierer G., Heiland S., Fischer C. et al. Cerebral MR perfusion imaging: first clinical application of a 1 M gadolinium chelate (Gadovist 1.0) in a double-blinded randomized dose-finding study. J. Magn. Res. Imag. 2000; 12 (3): 371–80. DOI: 10.1002/1522-2586(200009)12Benner T., Reimer P., Erb G., Schuierer G., Heiland S., Fischer C. et al. Cerebral MR perfusion imaging: first clinical application of a 1 M gadolinium chelate (Gadovist 1.0) in a double-blinded randomized dose-finding study. J. Magn. Res. Imag. 2000; 12 (3): 371–80. DOI: 10.1002/1522-2586(200009)12Rovira A., Auger C., Huerga E., Corral J.F., Mitjana R., Sastre-Garriga J., Montalban X. Cumulative dose of macrocyclic gadolinium-based contrast agent improves detection of enhancing lesions in patients with multiple sclerosis. Am. J. Neuroradiol. 2017; 38 (8): 1486–93. DOI: 10.3174/ajnr.a5253Rovira A., Auger C., Huerga E., Corral J.F., Mitjana R., Sastre-Garriga J., Montalban X. Cumulative dose of macrocyclic gadolinium-based contrast agent improves detection of enhancing lesions in patients with multiple sclerosis. Am. J. Neuroradiol. 2017; 38 (8): 1486–93. DOI: 10.3174/ajnr.a5253Брюхов В.В., Кротенкова И.А., Морозова С.Н., Кротенкова М.В. Стандартизация МРТ-исследований при рассеянном склерозе. Журнал неврологии и психиатрии им. С.С. Корсакова. 2016; 116 (10-2): 27–34. DOI: 10.17116/ jnevro201611610227-34Bryukhov V.V., Krotenkova I.A., Morozova S.N., Krotenkova M.V. Standartization of MRI studies in multiple sclerosis. S.S. Korsakov Journal of Neurology and Psychiatry.2016; 116 (10-2): 27–34 (in Russ.). DOI: 10.17116/ jnevro201611610227-34ESUR 8.1. European Society of Urogenital Radiology Guidelines on contrast agents. Version 8.1. 2012. European Society of Urogenital Radiology website; 2012. Available at: http://www.esur.org/guidelines/ESUR 8.1. European Society of Urogenital Radiology Guidelines on contrast agents. Version 8.1. 2012. European Society of Urogenital Radiology website; 2012. Available at: http://www.esur.org/guidelines/Pohl D., Alper G., Van Haren K., Kornberg A.J., Lucchinetti C.F., Tenembaum S., Belman A.L. Acute disseminated encephalomyelitis. Neurology. 2016; 87 (9; Suppl. 2): S38–S45. DOI: 10.1212/wnl.0000000000002825Pohl D., Alper G., Van Haren K., Kornberg A.J., Lucchinetti C.F., Tenembaum S., Belman A.L. Acute disseminated encephalomyelitis. Neurology. 2016; 87 (9; Suppl. 2): S38–S45. DOI: 10.1212/wnl.0000000000002825Callen D.J.A., Shroff M.M., Branson H.M., Li D.K., Lotze T., Stephens D., Banwell B.L. Role of MRI in the differentiation of ADEM from MS in children. Neurology. 2008; 72 (11): 968–73. DOI: 10.1212/01.wnl.0000338630.20412.45Callen D.J.A., Shroff M.M., Branson H.M., Li D.K., Lotze T., Stephens D., Banwell B.L. Role of MRI in the differentiation of ADEM from MS in children. Neurology. 2008; 72 (11): 968–73. DOI: 10.1212/01.wnl.0000338630.20412.45Koelman D.L.H., Benkeser D.C., Klein J.P., Mateen F.J. Acute disseminated encephalomyelitis: prognostic value of early follow-up brain MRI. J. Neurol. 2017; 264 (8): 1754–62. DOI: 10.1007/s00415-017-8563-3Koelman D.L.H., Benkeser D.C., Klein J.P., Mateen F.J. Acute disseminated encephalomyelitis: prognostic value of early follow-up brain MRI. J. Neurol. 2017; 264 (8): 1754–62. DOI: 10.1007/s00415-017-8563-3Misu T., Sato D.K., Nakashima I., Fujihara K. MOG-IgG serological status matters in paediatric ADEM. J. Neurol. Neurosurg. Psych. 2014; 86 (3): 242. DOI: 10.1136/jnnp-2014-308723Misu T., Sato D.K., Nakashima I., Fujihara K. MOG-IgG serological status matters in paediatric ADEM. J. Neurol. Neurosurg. Psych. 2014; 86 (3): 242. DOI: 10.1136/jnnp-2014-308723Sa M., Thornton R., Chong W.K., Kaliakatsos M., Hacohen Y. Paediatric MOG antibody – associated ADEM with complex movement disorder: a case report. Multiple Scler. J. 2018;25 (1): 125–8. DOI: 10.1177/1352458518786074Sa M., Thornton R., Chong W.K., Kaliakatsos M., Hacohen Y. Paediatric MOG antibody – associated ADEM with complex movement disorder: a case report. Multiple Scler. J. 2018;25 (1): 125–8. DOI: 10.1177/1352458518786074Vitt J.R., Brown E.G., Chow D.S., Josephson S.A. Confirmed case of levamisole-associated multifocal inflammatory leukoencephalopathy in a cocaine user. J. Neuroimmunol. 2017; 305: 128–30. DOI: 10.1016/j.jneuroim.2017.01.018Vitt J.R., Brown E.G., Chow D.S., Josephson S.A. Confirmed case of levamisole-associated multifocal inflammatory leukoencephalopathy in a cocaine user. J. Neuroimmunol. 2017; 305: 128–30. DOI: 10.1016/j.jneuroim.2017.01.018Franco D.A., Greenberg H.S. 5-FU multifocal inflammatory leukoencephalopathy and dihydropyrimidine dehydrogenase deficiency. Neurology. 2001; 56 (1): 110–2. DOI:10.1212/wnl.56.1.110Franco D.A., Greenberg H.S. 5-FU multifocal inflammatory leukoencephalopathy and dihydropyrimidine dehydrogenase deficiency. Neurology. 2001; 56 (1): 110–2. DOI:10.1212/wnl.56.1.110Шавловская О.А. Левамизол-индуцированная лейкоэнцефалопатия: клинический случай. Анналы клинической и экспериментальной неврологии. 2018; 12 (3): 75–80. DOI: 10.25692/ACEN.2018.3.10Shavlovskaya О.А. Levamisol-induced leukoencephalopathy: clinical case. Annals of Clinical and Experimental Neurology. 2018; 12 (3): 75–80 (in Russ.). DOI: 10.25692/ ACEN.2018.3.10Chen T.C., Hinton D.R., Leichman L., Atkinson R.D., Apuzzo M.L.J., Couldwell W.T. Multifocal inflammatory leukoencephalopathy associated with levamisole and 5-fluorouracil. Neurosurgery. 1994; 35 (6): 1138–43. DOI:10.1097/00006123-199412000-00019Chen T.C., Hinton D.R., Leichman L., Atkinson R.D., Apuzzo M.L.J., Couldwell W.T. Multifocal inflammatory leukoencephalopathy associated with levamisole and 5-fluorouracil. Neurosurgery. 1994; 35 (6): 1138–43. DOI:10.1097/00006123-199412000-00019Wingerchuk B.G., Wingerchuk D.M. Neuromyelitis optica spectrum disorders. Oxford Med. Online. 2016. DOI: 10.1093/ med/9780199341016.003.0023Wingerchuk B.G., Wingerchuk D.M. Neuromyelitis optica spectrum disorders. Oxford Med. Online. 2016. DOI: 10.1093/ med/9780199341016.003.0023Schreiner T.L., Bennett J.L. Neuromyelitis Optica. Oxford Med. Online. 2017. DOI: 10.1093/med/9780199937837.003.0088Schreiner T.L., Bennett J.L. Neuromyelitis Optica. Oxford Med. Online. 2017. DOI: 10.1093/med/9780199937837.003.0088Filippi M., Rocca M.A. MR imaging of Devic’s neuromyelitis optica. Neurol. Sc. 2004; 25 (S4): s371–3. DOI:10.1007/s10072-004-0344-yFilippi M., Rocca M.A. MR imaging of Devic’s neuromyelitis optica. Neurol. Sc. 2004; 25 (S4): s371–3. DOI:10.1007/s10072-004-0344-y

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