创伤性无骨折脱位型椎管内硬膜外血肿的MRI表现

目的探讨创伤性无骨折脱位型脊髓硬膜外血肿（TSEH）的MRI表现特点及其鉴别诊断。方法对12例TSEH常规行T1WI矢状位，T2WI矢状位及横轴位MRI扫描。结果12例TSEH中，9例位于椎管腹侧，3例位于椎管背侧，呈新月状或长条带状，分别累及2～6个脊髓节段，平均3．5个脊髓节段。血肿位于颈段4例，颈胸段3例，胸段3例，胸腰段2例。7例血肿T1WI上为等信号，T2wI低信号；2例血肿T1WI为稍高信号，T2WI呈不均质性高信号，3例于T1WI及T2WI均为高信号。血肿于T1WI及T2WI与脊髓之间有一低信号带相隔，尤以T2WI显示最佳。结论MRI是诊断TSEH的最佳检查方法，不仅可以清楚地显示血肿的部位及范围，而且可以清楚地显示血肿新旧程度及脊髓受损的情况。     

脊髓血管母细胞瘤的MRI特点

【摘要】〓目的〓分析探讨脊髓血管母细胞瘤的MRI表现特征。方法〓回顾性分析经手术病理证实的7例脊髓血管母细胞瘤的临床及MRI表现。全部患者均行MRI平扫及增强扫描。结果〓单发6例,多发1例,共有脊髓血管母细胞瘤病灶8个,所有病灶均位于髓内。其中,延髓1个,颈段4个,胸段2个,腰段1个。肿瘤多呈点状、结节状、香肠状或不规则形状,肿瘤在MRI T1WI呈等或稍低信号,T2WI呈稍高信号,增强扫描上下径<20 mm的病灶呈明显、均匀强化,上下径>20 mm的病灶呈明显不均匀强化,其内可见多发流空的血管影;7例患者均伴有不同程度脊髓空洞或水肿。结论〓脊髓血管母细胞在MRI中具有特征性的影像表现,MRI对诊断脊髓血管母细胞瘤具有重要价值。     

慢性压迫性颈脊髓病的手术疗效与MRI表现分析

目的：分析慢性压迫性颈脊髓病的MRI表现,探讨术前预测慢性压迫性颈脊髓病手术疗效的意义。方法：对115例慢性压迫性颈脊髓病患者的MRI和术后半年以上复查的81例MRI图像,选椎管矢径最窄节段脊髓进行分辨、测量和对照,并依据脊髓功能40分评分法对疗效进行评定。结果：髓内有边界清楚局限性T1WI低或等信号、T2WI高信号灶的26例,术后玉术前MRI各测量值皆无显著性差异（P＞0.05）,术后改善率＜30％。髓内无上述异常信号灶的89例,其术后MRI各值及改善率与术前髓断面积、髓断面积与管断面积比值大小呈正相关。结论：术前髓内有无边界清楚局限性T1WI、T2WI异常信号灶、髓断面积的大小、髓断面积与管断面积比值可作为预测手术疗效的依据。     

原发颈胸段骨肿瘤的MRI诊断及临床意义

目的：分析原发颈胸段骨肿瘤的MRI表现。材料与方法；采用美国GE公司2.0tsl扫描仪，扫描序列包括，矢状位，冠状位，横轴位T1WI。选择26例经术后病理和临床证实的颈胸段肿瘤，分别观察椎体，附件，椎间盘病变情况。椎体溶骨及软组织肿块MRI情况。结果：颈胸段原发肿瘤溶骨破坏均为T1WI高信号，软组织阴影T2WI为高信号，各种肿瘤又有不同影表现。结论：MRI对颈胸段原发肿瘤具有订前判断诊断价值。     

脊髓海绵状血管瘤的诊断和治疗

目的　探讨脊髓海绵状血管瘤的诊断和治疗方法以指导临床。　方法　回顾分析 2 3例脊髓髓内海绵状血管瘤患者的临床特征、诊断和治疗方法 ,并采用Aminoff&Logue评分标准评价患者术前术后的脊髓功能。　结果　 2例患者拒绝手术而保守治疗 ,2 1例手术治疗 ,术后病理证实为海绵状血管瘤。血管瘤全切除 18例 ,次全切除 3例。术后患者症状好转 15例 ,无变化 4例 ,加重 2例 ,无手术死亡。　结论　MRI对脊髓海绵状血管瘤诊断的特异性高 ,手术治疗效果好 ,有症状者应积极手术。     

颈段脊髓内室管膜瘤的显微手术策略及疗效评价

目的 探讨显微外科手术切除颈段脊髓内室管膜瘤的显微手术策略和技巧及临床疗效.方法 对颈段脊髓内室管膜瘤施行显微手术治疗14例,回顾性分析临床特征、影像学表现、诊断、全切除肿瘤保留脊髓功能的显微手术技巧以及术前、术后神经功能改变.结果 肿瘤全切除12例,次全切除2例.术后临床神经功能改善9例,保留术前神经功能4例,术后症状加重1例;术后无死亡病例.随访4～50个月,14例复查MRI均无复发.结论 显微手术切除是颈段脊髓内室管膜瘤的首选治疗方法,正确的手术策略和熟练的显微技巧是提高颈段脊髓内室管膜瘤的手术疗效的基础.     

颈胸段脊柱脊髓伤的诊断及前路手术治疗

目的 探讨颈胸段脊柱脊髓损伤的临床特点、诊断及颈胸段前路减压、植骨、Orion钢板内固定术的治疗作用。方法 分析26例颈胸段脊柱骨折、脱位患者的临床表现;行颈胸段前路C7、T1、C6－7或C7－T1椎体次全切除、植骨及Oron锁定型颈椎前路钢板固定术。结果 颈胸段脊柱脊髓损伤患者通常表现为C8－T1或T2相应节段脊髓神经根症状,10例伴有窦性心动过缓、8例出现低血压、7例出现Horner征等交感节刺激症状。所有患者随访3－20个月,植骨均在3－4个月内完全融合,20例脊髓神经功能有不同程度的改善,上述交感神经节刺激疾病缓解,1术后出现暂时性声音嘶哑。结论 颈胸段脊柱脊髓损伤根据其临床特点、影像学表现可确定诊断;颈胸段前路减压、植骨、Orion钢板内固定术对颈胸段脊柱脊髓损伤具有较好的疗效,Orion钢板有助于植骨节段融合、重建和稳定颈胸段脊柱。     

无骨折脱位型急性颈脊髓损伤的MRI特点及意义

目的探讨无骨折脱位型急性颈脊髓损伤的MRI改变特点及其在脊髓损伤程度、预后及治疗中的作用。方法回顾性分析26例无骨折脱位型急性颈脊髓损伤的MRI和临床资料。结果无骨折脱位型急性颈脊髓损伤MRI绝大多数表现为脊髓水肿，急性期T1加权像等信号，T2加权像高信号。慢性期部分T1加权像局限性低信号，T2加权像局限性高信号。MRI T2加权像单节段脊髓水肿预后较双节段以上者好。结论无骨折脱位型急性颈脊髓损伤MRI信号改变及其范围能反映脊髓损伤程度，提示预后，指导治疗。     

脊髓内畸胎瘤2例报告

畸胎瘤发生于脊髓内在临床上较少见。1999～2002年我们共收治2例，现结合文献报告如下。例1，女，22岁。排尿困难2年伴左下肢肌无力。查体：左侧股四头肌肌力3级，小腿外侧感觉减退。考虑为椎管内占位性病变。MRI检查于L2～L3节段脊髓内见有不规则异常信号，T2信号略不均匀，其境界不规则，周围软组织膨胀性生长，此部分椎管内体积完全被肿物占据，但其与硬膜、室管膜无明显粘连，上端蛛网膜下腔受阻，下端部分脂肪堆积，呈长T2短T1信号，增强扫描示肿瘤无明显强化效应。拟诊为L2～L3节段脊髓内畸胎瘤。行显微手术切除，病理诊断为畸胎…     

创伤性颈脊髓损伤的早晚期手术疗效比较

[目的]评价创伤性颈脊髓损伤早期手术的效果及MRI揭示预后的价值. [方法]2001年9月～2004年8月,对36例创伤性颈脊髓损伤患者行手术治疗,伤后72 h内为早期手术,72 h后为晚期手术.术前MRI T2加权像髓内信号改变长度>20 mm为长变化,信号改变≤20 mm或无明显信号改变为短变化.随访时间为24～48个月,平均32个月.采用日本骨科学会(JOA)标准进行入院时和随访时脊髓功能评分,通过计算恢复率评价神经改善状况. [结果]术后24个月随访时,早期手术组恢复率高于晚期手术组(P<0.01);MRI T2加权像信号短变化组恢复率高于信号长变化组(P<0.01),差异均有统计学意义.不同手术时机与MRI T2加权像脊髓信号改变间存在交互作用. [结论]创伤性颈脊髓损伤后,手术时间越早,MRI T2加权像脊髓信号变化越短,术后神经功能恢复率越高.     

应用ellman射频电波刀治疗颅内海绵状血管瘤

目的 总结颅内海绵状血管瘤的临床特点和应用ellman射频电波刀治疗的体会。方法 回顾与分析我们自2001年6月～2003年5月共2年间手术治疗的21例颅内海绵状血管瘤，在显微镜下，采用ellman射频电波刀进行血管肿瘤切除。结果 根据头颅CT、MRI及手术所见将21例患者分为2种类型，Ⅰ型：19例，病变位于脑内，均获得镜下全切除，术后症状获得不同程度改善；Ⅱ型：2例，病变位于脑外，获得镜下大部分切除(1例术前给予放射治疗)。结论 正确诊断颅内海绵状血管瘤、以及恰当的手术治疗是获得良好预后的基础。     

DISCO CE-MRA在上肢血管疾病中的应用价值研究

目的:探讨基于笛卡尔采集的K空间共享三维容积(DISCO)对比增强磁共振血管成像技术(CE-MRA)在上肢血管疾病中的应用价值.方法:回顾性分析2020年5月至2021年4月入院治疗的20例临床诊断上肢血管性病变患者的影像学资料.患者入院后均行DISCO CE-MRA检查,其中11例患者行DSA检查,2例患者行手术治疗...     

Capillary hemangioma of the spinal cord. A new case

A 49-year-old man presented with a 8-month history of gait and sphincter disturbances. Examination revealed a spastic paraplegia predominant on the left limb, associated with decreased tactile sensitivity below T10. MRI showed a right posterolateral intramedullary lesion with an isosignal on T1-weighted images and a mild hypersignal on T2-weighted images, with an intense contrast enhancement; the spinal cord presented with an hypersignal on T2-weighted images. At operation, a vascular tumor presented at the spinal cord surface, was well demarcated from the parenchyma and was easily removed. Microscopic examination showed a capillary hemangioma. Three months later the patient exhibited a motor improvement with a right spasticity, deficits in proprioception, without sphincter abnormalities. A new MRI showed the disappearance of the hemangioma and of the preoperative spinal cord hypersignal. Capillary hemangiomas are unusual on nerves or roots. Cases found in the spinal cord are extremely rare: to our knowledge, 5 cases have been reported. On MRI, they are easily distinguished from cavernous hemangiomas, but microscopic examination is necessary to distinguish them from hemangioreticulomas. The postoperative prognosis is generally good. However, a report of a multiple location case, on roots and spinal cord, suggests the need for long follow-up.     

外伤性颈内动脉海绵窦瘘的诊断与介入栓塞治疗（附4例报告）

[摘要]目的探讨外伤性颈内动脉海绵窦瘘的诊断和血管内治疗。方法对有头部外伤病史及典型临床表现的患者积极行数字减影血管造影（digitalsubtractionangiography,DSA）检查,有4例确诊后经股动脉入路,用可脱性球囊进行栓塞治疗。3例保持了患侧颈内动脉的通畅,1例行瘘口远近端的颈内动脉闭塞术;3例患者应用1个球囊,1例应用2个球囊。结果4例患者瘘I：1完全闭塞,临床症状缓解,1例于首次术后12h症状再发,再次行栓塞治疗后缓解痊愈。结论DSA检查是诊断颈内动脉海绵窦瘘的金标准;可脱性球囊栓塞治疗是颈内动脉海绵窦瘘的首选治疗方法。     

椎体血管瘤诊治策略

目的探讨不同部位、不同类型椎体血管瘤的诊治策略。方法回顾性分析2000年1月至2011年6月收治的22例症状性椎体血管瘤病例,对不同部位、不同类型（依据MRI表现）的椎体血管瘤采取相应的治疗方法,观察患者治疗后症状缓解情况,同时记录并比较18例手术患者手术前后VAS评分。结果对4例颈椎症状性椎体血管瘤（病变椎体核磁信号为T1WI呈中高信号,T2WI呈高信号,属海绵状椎体血管瘤）行放射治疗;对18例颈椎以下症状性椎体血管瘤（病变椎体核磁信号为T1WI呈低信号,T2WI呈高信号,属毛细血管状椎体血管瘤）中的15例行经皮椎体成形术,3例行脊柱后路开放手术。随访4～60个月（平均26个月）,患者症状明显缓解,无手术相关并发症发生。手术病例VAS评分较术前有明显改善（P〈0.05）。结论 MRI影像学评估对椎体血管瘤的诊断和治疗具有指导意义。对不同部位及不同类型的椎体血管瘤选择个性化的治疗策略,效果良好。     

Intrascrotal hemangioma

Although hemangiomas are the most common benign tumors in infancy, scrotal hemangiomas are extremely rare and comprise less than 1% of all hemangiomas. Scrotal hemangiomas that extend into adjacent areas of the perineum, thigh, or anterior abdominal wall may occasionally be seen. Ultrasound is recommended as part of the preoperative assessment delineating the extent of a scrotal hemangioma. Since an absence of flow on Doppler studies does not exclude the diagnosis of hemangioma, MRI (magnetic resonance imaging) may provide more useful information for differentiation. In cases of cutaneous scrotal hemangiomas, conservative treatment that waits for involution is widely accepted. In patients with scrotal masses, exploration with excision is the treatment of choice even if a hemangioma is likely. The authors report a case of an intrascrotal tumor diagnosed preoperatively by color duplex ultrasonography and MRI in a 19-year-old male who subsequently underwent en bloc excision. Pathological examination identified a cavernous hemangioma.     

Spinal epidural cavernous hemangioma. Case report

Spinal epidural cavernous hemangiomas are very rare; only 18 cases have been reported in the literature. The authors describe the case of a 38-year-old male whose first symptom was numbness of the foot, which, after 2 years, spread to the abdomen. On admission, he had no weakness but exhibited hyper-reflex of the lower limbs and hypalgesia below the 7th thoracic dermatome. Magnetic resonance imaging (MRI) revealed an extradural tumor at the level of the 7th thoracic vertebra, with erosion of the 7th vertebral body. T1-weighted images were obtained by inversion recovery with a repetition time (TR) of 2100 msec, an inversion time of 600 msec, and an echo time (TE) of 40 msec. T2-weighted images were obtained by a spin echo pulse sequence with a TR of 2000 msec and a TE of 120 msec. Compared with the spinal cord, the tumor showed low intensity on T1-weighted images and high intensity on T2-weighted images. The tumor was removed through a laminectomy. The histological diagnosis was cavernous hemangioma. After surgery, the patient's symptoms and signs improved. This is the first report of a spinal epidural cavernous hemangioma that includes MRI findings. It appears difficult to differentiate cavernous angiomas from neurinomas by MRI.     

肝海绵状血管瘤的诊断与治疗(附84例报告)

总结肝海绵状血管瘤的诊断和治疗经验。方法１９９０－１９９５年１２月我科共收治经手术证实的肝海绵状血管瘤８４例,肿瘤平均直径９．８ｃｍ,最大直径约４０ｃｍ,其中位于Ⅷ段或累及Ⅷ段１２例,位于尾状叶或累及尾状叶４例。术前有４例在外院接受肝动脉栓塞或化疗栓塞治疗。结果术前确诊率为９５．２％,手术切除率９８．８％,无手术死亡及严重并发症。结论手术是治疗肝海绵状血管瘤最有效的治疗手段,栓塞治疗存在较大危险。     

Vertebral hemangioma extending into the spinal canal: case report

A 73-year-old woman was admitted to our hospital presenting slowly progressive hypoesthesia below the 5th thoracic dermatome and spastic paraparesis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in the T3 vertebral body extending into the spinal canal. The spinal cord was compressed to the left side and right T3 and T4 nerve roots were encased in the mass lesion. One week after admission, T2-T4 laminectomy was performed to relieve the spinal cord compression. A highly vascularized tumor was observed in the epidural space at T3 and T4 levels. The tumor in the spinal canal was removed. The histopathological diagnosis was cavernous hemangioma. The patient's symptoms improved after the surgery. Asymptomatic vertebral hemangiomas are common, but its extraosseus extension causing neurologic symptoms (compressive vertebral hemangioma) is rare. The clinical symptoms, the radiological features, and the strategies for the treatment of compressive vertebral hemangiomas were discussed.     

Spinal intradural extramedullary cavernous angioma: case report and review of the literature

STUDY DESIGN: Case report and review of the literature. OBJECTIVE: To report an unusual case of a spinal intradural extramedullary cavernous angioma (CA), located at the cauda equina, and to compare it with the previously published 22 surgically treated cases in the literature. SETTING: Ankara, Turkey. METHOD: A 67-year-old man presented with a 4-month history of back pain and sciatica and a 4-week history of progressive lower extremity paresthesia, difficulty walking, and loss of bladder and bowel sphincter control. Neurological examination revealed bilateral hypoesthesia below the T12 dermatome with spastic paraparesis. Magnetic resonance imaging (MRI) of the cauda equina revealed a heterogeneous enhancing intradural extramedullary mass obliterating the spinal canal and expanding the spinal cord. T12 laminectomy and total tumor removal were performed without additional neurological deficit. Pathological examination confirmed the diagnosis of a CA. RESULT: The patient's neurological status improved during postoperative recovery. He was ambulatory without assistance and regained full sphincter control on the eighth postoperative week. CONCLUSION: CAs of the spinal cord are extremely rare lesions. Typically, they present with low back pain and sciatica, neurological deficits, or as a subarachnoid hemorrhage. These lesions have characteristic features on MRI and should be considered in the differential diagnosis of intradural spinal lesions. Following a thorough literature review of reported cases, the authors propose that for patients presenting with severe preoperative neurological signs, immediate microsurgical tumor excision or decompression increases the chance of neurological improvement.