Clinical and MRI features in pediatric multiple sclerosis / 中华放射学杂志

ABSTRACT

ObjectiveTo investigate the clinical and MRI features of multiple sclerosis in children,including the clinically isolated syndrome (CIS) and relapse.MethodsIn total,16 cases of pediatric multiple sclerosis were included in this study.Of them,11 patients were female and 5 were male,with the mean onset age of 10.1 years.They were followed up for 4 months to 7 years and found to have 1-5 relapses.The clinical manifestations of CIS and relapse were analyzed by a pediatric neurologist.An experienced neuroradiologist reviewed the MRI images of CIS and relapse.Information on the location,size,and pattern of the lesions was gathered.The location of lesions included subcortical,central,and periventricular white matter,cortex,deep gray matter,brain stem,and cerebellum.ResultsCIS episode presented acute onsets in 13/16 cases,with symptoms of cortice in 10 cases and visual impairment in 6 cases.Relapse occurred in 14/16 cases within one year.The incidence of symptoms of cortice was less frequent and severe in the second episode of MS,whereas the visual impairment had a high incidence.All patients had full recovery after the last episode.MRI of CIS showed confluent subcortical white matter lesions in 13/16 cases,abutting on central white matter lesions.The most frequently involved brain part was the frontal lobe,followed by the parietal lobe.Cortical involvement was observed in 9/16 cases.In 6 cases,periventricular white matter lesions were detected.Bilateral deep gray matter was abnormal in 4 cases.Other abnormalities included brain stem lesions in 5 cases,cerebellum lesions in 3 cases,optic nerve involvement in 3 cases,and pyramidal tract lesions in 2 cases.MRI of relapse revealed more small lesions in the subcortial and periventricular white matter in the patients.In the second episode,only 2 cases presented cortical involvement.Lesions were found in the brain stem in 4 cases and in the cerebellum in 5 cases.Pyramidal tract involvement was identified in 6 cases,serving as “railway track sign”.ConclusionsCIS in children is characterized by large confluent lesions in subcortical white matter coalescing with central white matter.MRI of relapse showed distinctive “railway track sign”.It is important to integrate MRI and clinical features in the diagnosis of pediatric multiple sclerosis.