Objective To compare the imaging characteristics of multiple sclerosis (MS) and neuromyelitis optica (NMO) for better diagnosis and differential diagnosis.Methods The brain and spinal MRI images of 60 MS and 48 NMO cases were retrospectively reviewed.The imaging characteristics including the predilection site,morphological features,enhancement manifestations were summarized.All data was analyzed by using t test and Chi square test with SPSS 13.0.Results (1) The three top predilection sites of brain in head MRI of MS patients were periventricular white matter (34 cases in 60),subcortical white matter (27 cases in 60),brain stem (23 cases in 60).MS lesions also were found in basal ganglia,cerebellum,corpus callosum and thalamus,as well as cortex (9 cases in 60).By contrast,brain lesions were observed in 59.4％ (19/32) of NMO patients,and the three top predilection sites of NMO by turns were brain stem (13 cases in 19),periventricular white matter (12 cases in 19),subcortical white matter (7 cases in 19).Furthermore,the lesions surrounding third ventricle (6 cases in 19) and the tegmentum of brain stem near peri-aqueduct (8 cases in 19) in NMO were not found in patients of MS.The involvement of brain stem and thalamus was more frequent in NMO than in MS (x2 =5.267,6.004,P ＜0.05,respectively).(2) The lesions of spinal cord in MS patients were typically oval,peripheral,and asymmetric,but in NMO patients they were longitudinally extensive and centrally located.The mean number of involved vertebral segments in NMO patients was significantly more than that in MS patients (7.3 vs 2.2,t =-9.288,P ＜ 0.01).Furthermore,the number of spinal cord lesions in MS patients was remarkably more than that in NMO (2.0 vs 1.3,t =4.565,P ＜0.01).The ratios of occurrence of spinal cord swelling and distension of NMO patients was 58.3％ (28/48),which was significantly higher than 21.9％ in MS (7/32,x2 =10.370,P ＜0.01).(3)The enhancement pattern in MS was circular (7 cases in 42),oval (6 cases in 42) and irregular (4 cases in 42),while in NMO was mainly sheet-shaped with mild enhancement (5/11).The lesions of spinal cord showed in MS mainly manifested as oval enhancement (16 cases in 26) and linear enhancement (8 cases in 26),while in NMO lesions manifested as strand or mild linear enhancement (26 cases in 35).Conclusions NMO has several distinct imaging characteristics,which are helpful for differentiation from MS.

Objective To explore the value of brain CT scanning for distinguishing tumor-like inflammatory demyelinating diseases (TIDD) from glioma or primary central nervous system lymphoma.Methods The brain CT features in 20 patients with TIDD(10 female,10 male;mean age (35.6±14.0)years;range,6-51 years)and 32 gliomas(16 female,16 male;mean age(42.0±19.8)years;range,12-75 years)and 6 lymphomas(3 female,3 male;mean age(53.8±11.8)years;range,32-68 years)were retrospectively reviewed and compared between brain tumors and TIDD.Results (1)Among the 38 primary brain tumors,there were 19 cases(50%,14 gliomas,5 lymphomas)with hyperdense lesions,10 cases(26.3%,9 gliomas,1 lymphomas)with isodense lesions,and 9 glionms (23.7%)with hypodense lesions.In contrast,the brain unenhanced CT manifestation of 20 TIDD all showed with hypodense lesions.(2)On unenhanced CT the lesions of 6 lymphomas all were hyperdense or isodense,like 90% of 20 high grade gliomas(WHO grade Ⅲ and Ⅳ),but this rate for grade Ⅱ was only 41.7%.(3)According to the shape of hyperdense lesions of the 19 primary brain tumors with,7 cages(6 gliomas,1 lymphomas)manifested with asymmetric hyperdense small-patches,4 cases(1 gliomas,3 lymphomas)with symmetric hyperdense large-patches,4 cases(3 gliomas,1 lymphomas)with diffused hyperdensed lesions,and 4 cases(4 gliomas)with ring-shaped hyperdensed lesions.Furthermore,4 primary brain tumors(4 lymphomas)underwent CT enhanced scanning and all the cases showed strong enhancement(3 cases with hyperdense lesions and 1 with isodense lesions on unenhanced CT),but only 3 cases of 7 TIDD showed mild enhancement in contrast.(4)By Spearman's relevant analysis,hyperdense and isodense on unenhanced CT was proved to have significant positive correlation between the grade of gliomas(r=0.435,P=0.013).Therefore,the frequency of hyperdense and isodense lesions in lymphomas and WHO grade Ⅲ and Ⅳ astrocytoma was higher in contrast with low grade astrocytoma.Conclusions Brain CT as a simple,economical and practical examination method has significant meaning for differentiating TIDD from glioma or PCNSL and could be used as an adjuvant method for MRI and magnetic resonance spectroscopy.Patients with hyperdense or isodense on unenhanced CT or strong enhancement could be excluded from TIDD.

Objective To investigate the change of serum cancer antigen(CA) 125 in patients with pleural effusion.Methods One hundred and twenty-eight patients with pleural effusion were admitted to the Naval General Hospital of People's Liberation Army from January 2010 to September 2012 were selected as our subjects.The level of serum CA125 was measured.The difference of serum CA125 positive rate and level were compared according to gender,pleural effusion nature,quantity and pleural effusion chest area; And the difference of patients with malignant pleural effusion tuberculosis,inflammatory,exudative pleural effusion based on above indicators.The correlation between serum CA125 level and pleural effusion depth were analyzed.Results The positive proportions of CA125 were 83.3％ (35/42) and 76.7 ％ (66/88) of patients with malignant and benign effusion respectively,and there was no significant difference (x2 =0.74,P ＞ 0.05).The serum CA125 level of patients with malignant pleural effusion was significantly higher than benign ones ((177.8 ± 31.4) U/ml vs.(110.6 ± 13.6) U/ml,t =31.24,P ＜ 0.05).There were no significant difference in the positive proportion of serum CA125 between malignant,tuberculous,inflammatory and transudative pleural effusion(75.8％ (25/33),70.0％ (20/29),87.5％ (21/24) and 83.3％ (35/42),P ＞ 0.05).Serum CA125 levels of patients with malignant pleural effusion were significantly higher than that with inflammatory ((177.8 ± 31.4) U/ml vs.(72.5 ± 12.8) U/ml,P ＜ 0.05),but the differences were not significant among malignant,tuberculous and transudative pleural effusion group((140.6 ± 28.2) U/ml,(154.3 ± 30.5) U/ml,P ＞ 0.05).The serum CA125 levels of patients with small,moderate and large effusions were (56.4 ± 18.2) U/ml,(120.2 ± 24.5) U/ml and (185.5 ± 34.6) U/ml respectively,and the difference among these groups were significant(F =296.03,P ＜ 0.05).Serum CA125 levels was positively correlated with pleural fluid depth (r =0.56,P ＜0.01).Different gender,pleural effusion parts serum CA125 positive rate and the different levels were not statistically significant (P ＞ 0.05).Conclusion Serum CA125 increased in patients with benign and malignant pleural effusion,and serum CA125 was not severed as the diagnosis biomarker in differentiating benign and malignant pleural effusion.Serum CA125 levels is helpful in monitoring the change of pleural fluid size due to the relation with depth of pleural fluid.