椎管内肠源性囊肿的MRI与临床诊断

目的 探讨椎管内肠源性囊肿的MRI与临床表现,旨在提高对该病的认识与诊断水平。资料与方法 回顾性分析经手术病理证实的7例椎管内肠源性囊肿患者的MRI及临床资料,并复习相关文献。结果 7例椎管内肠源性囊肿均发生于髓外硬膜下,4例位于脊髓腹侧,3例位于背侧。脊髓受压变窄。平扫T1WI上类似或稍高于脑脊液信号,T2WI上为脑脊液样信号。增强扫描无明显强化。临床表现以脊髓压迫症状为主,均有短期内症状进行性加重的病程特点。结论 MRI对椎管内肠源性囊肿的诊断和鉴别诊断具有重要价值,对指导治疗及评价预后十分重要。     

Thoracic spinal intradural arachnoid cyst: report of two cases and review of literature

We report two cases of spinal intradural arachnoid cyst at the thoracic level, presenting with long-standing symptoms of spinal cord compression and MRI findings that were overlooked for sometime initially. Because of the rarity of this disease, and because of the subtle changes on MRI, there was a definite delay in the diagnosis. In this report we emphasize the value of MRI and CT myelography in this disorder, and the need for them to be strongly correlated with the progression of the clinical picture.     

Atlantoaxial Joint Synovial Cyst: Diagnosis and Percutaneous Treatment

Synovial cysts at the atlantoaxial level are found uncommonly. Lumbar symptomatic cases are treated by percutaneous cyst aspiration with or without corticoid injection or by surgical resection, but synovial cysts at the C1-C2 level are usually treated by surgery. We report here a 92-year-old woman with a retro-odontoid synovial cyst producing spinal cord compression that was treated by percutaneous aspiration of the cyst under CT guidance. To our knowledge, this is the first reported case of an atlantoaxial synovial cyst successfully treated with a minimally invasive procedure.     

Ossification of the posterior longitudinal ligament and ligamentum flavum: imaging features

Ossifications of the posterior longitudinal ligament and ligamentum flavum are both special subcategories of degenerative diseases responsible for compression of the spinal cord. Ossification of the ligaments is well demonstrated by plain radiography and computed tomography. Magnetic resonance imaging noninvasively provides useful information about the degree and extent of spinal cord compression as well as the character of the ossification. T2-weighted sequences are most effective to evaluate both spinal cord compression due to the ossification and abnormal signal intensity of the spinal cord.     

创伤后脊髓囊变的MRI研究

目的 :探讨创伤后脊髓囊变的MRI表现及与其临床预后的关系。材料和方法 :回顾性分析 67例脊髓囊变病例的临床和MRI表现。结果 :67例伤后髓内囊变 ,颈髓 3 9例 ,胸髓 2 8例 ,囊变的位置与脊柱骨折、脱位位置一致 ;囊变的平均长度 (T1WI矢状位上下范围 )为 14mm ;脊髓囊变的信号变化同脑脊液 ;其大小、形态、位置同临床症状无明显关系。结论 :髓内囊变是慢性期脊髓损伤常见的病理改变 ;髓内囊变是同一水平骨折、脱位椎体直接撞击脊髓引起。髓内囊变为一局限性、稳定性病变。     

核磁共振成像在脊髓损伤中的应用

核磁共振成像（ＭＲＩ）在脊髓损伤的诊台中具有重要的意义：ＭＲＩ上表现为出血者较单纯水肿者的病情重,预后差,且均与病灶的大小有关;有脊髓压迫者的病情重,预后差;ＭＲＩ对指导创伤性脊髓空洞症的治疗也有重要的价值。     

慢性脊髓创伤的MRI表现

目的　探讨慢性脊髓损伤的MRI表现及其形成机制。材料与方法　分析 2 8例慢性脊髓损伤者的MRI表现及临床资料 ,其中男 2 1例 ,女 7例 ,平均年龄 39岁。伤后行MRI复查时间为 1个月～ 12年。MRI取常规SE序列T1WI、T2 WI矢状、横断面。结果　 2 8例中有 16例发生在颈髓 ,上胸髓及脊髓圆锥各 6例。其中脊髓囊变 13例 ;慢性脊髓受压 5例 ,均合并有其他类型的病理改变 ;脊髓软化 4例 ;脊髓空洞 2例 ;脊髓萎缩 3例 ;脊髓栓系 1例。结论　慢性脊髓损伤分别表现为脊髓囊变、空洞、萎缩、软化、栓系及慢性受压 6种病变 ,脊髓囊变与脊髓瞬间压迫伤有关 ,其病变局限。脊髓空洞及脊髓萎缩均与脊髓持续受压有关 ,病变潜在进展。脊髓软化可能由伤后脊髓缺血引起 ,脊髓栓系是伤后蛛网膜粘连造成     

Prediction of neurologic outcome in acute spinal cord injury: the role of CT and MR.

PURPOSE: 1) To determine whether MR appearances of the spinal cord in acute trauma correlate with clinical prognosis, and 2) to identify other MR and CT prognostic factors in acute spinal trauma. METHODS: Retrospective evaluation of MR, CT, and clinical examinations in 32 acute spinal trauma patients examined between 1987 and 1990. RESULTS: All 21 patients with abnormal spinal cords on MR had complete motor paralysis at presentation, compared to only three of 11 patients with normal cords. Whereas cord transection and hemorrhagic contusion had poor prognoses, 73% of patients with cord edema and 100% of patients with normal cord had useful motor function at outcome. At follow-up MR, areas of cord contusion developed into cysts, while edema resolved, leaving residual areas of myelomalacia. Associated spinal fractures, ligament injury, and cord compression were associated (P < .05) with a worse prognosis. Spondylotic changes were a significant risk factor for spinal cord injury, mediated by cord compression. CONCLUSIONS: MR and CT are valuable techniques for quantifying injury and predicting prognosis in acute spinal trauma.     

Invited. Ossification of posterior longitudinal ligaments: Evaluation with MRI

Ossification of the posterior longitudinal ligament is a special subcategory of degenerative disease responsible for compression of the spinal cord. On MR images, T2-weighted sequences are the most effective to evaluate both spinal cord compression due to the ossification and abnormal signal intensity of the cord. Although ossification of the ligaments is well demonstrated on CT and plain radiographs, MRI noninvasively provides useful information about the degree and extent of spinal cord compression, as well as the character of the ossification.     

持续性压迫对损伤脊髓组织学变化的影响

目的观察急性脊髓损伤后所存在的压迫物对损伤脊髓的血流量及病理变化的影响。方法对急性脊髓损伤伴压迫组动物和非压迫组动物伤部脊髓行血流量测定及光镜、电镜观察。结果（１）压迫对急性损伤脊髓血流量下降幅度影响不大，却影响了伤部脊髓血流量恢复。（２）长时间的压迫使伤部脊髓病理改变呈进行性加重。结论脊髓损伤后持续性压迫使损伤脊髓血流量恢复减慢，病理损害加重。     

Delayed neurologic deterioration in the patient with spinal trauma: role of MR imaging.

PURPOSE: To 1) correlate spinal MR features and modes of clinical presentation associated with symptomatic neurologic deterioration following longstanding spinal trauma; 2) correlate degree of neurologic deficit with spinal MR appearance in these patients; and 3) determine the relationship between new symptoms and ongoing cord compression. METHODS: Retrospective examination of MR images, and correlation with clinical data, in 94 consecutive patients. RESULTS: Sixty-seven patients presented with either an increase in degree of myelopathy or ascending neurologic level. Spinal cord atrophy (43%), syrinx (41%), and cord compression (24%) were found most frequently. Whereas in patients with complete motor and sensory deficit cord atrophy was the most frequent finding (52%), 75% of patients with useful motor function had normal spinal cords. There was a significant association (P less than .05) between cord compression and the MR findings of cord atrophy and myelomalacia, whereas a normal cord was over twice as frequent in patients without spinal cord compression. MR imaging led to an active change in management in 15% of patients, with improvement following surgery in all operated cases. CONCLUSION: Although syrinx is a frequent, and treatable cause of delayed neurologic deterioration, MR will frequently show other abnormalities such as ongoing cord compression. MR imaging should be performed urgently in all patients with new symptoms to enable early treatment to prevent irreversible loss of function.     

A patient with lung cancer metastatic to the fifth thoracic vertebra and spinal cord compression treated with percutaneous vertebroplasty and I-125 seed implantation

Percutaneous vertebroplasty is a minimally invasive surgical technique for the treatment of spinal damage and pathological compression fractures. Iodine-125 (I-125) particles can inhibit the uncontrolled proliferation of tumor cells to achieve anti-tumor effects. We report treating a spinal cord compression and T5 metastatic lung cancer patient through percutaneous vertebroplasty and I-125 seed implantation. Three years of follow-up demonstrated that our surgical plan achieved a satisfactory clinical outcome with good postsurgical recovery of spinal column function and relieved the symptoms of spinal cord compression.     

椎管内肠源性囊肿的磁共振影像诊断

目的：研究椎管内肠源性囊肿的磁共振影像学特征．材料和方法：收集了19例经手术和病理证实的椎管内肠源性囊肿的资料。分析其磁共振影像表现。结果：19例椎管内肠源性囊肿中．位于硬膜下18例，位于硬膜外1例．病变量常见部位是胸段椎管内(47%)，其次为颈段(37%)和颅椎结合部(16%)；18例(95%)囊肿位于中线部位脊髓腹侧面10例肠源性囊肿患者同时伴有脊柱的其它畸形．19例肠源性囊肿的磁共振影像表现包括：T1加权像上为脑脊液信号强度影5例，稍高于脑脊液信号强度影13例．与脊髓信号强度近似者1例；T1加权像时，7例囊肿信号强度等于脑脊液信号强度。2例稍高于脑脊液信号强度．所有囊肿的壁均光滑．囊内信号均匀．15例在磁共振横断面图像上见囊肿部分或大部分被镶嵌在脊髓中。结论：磁共振影像可以清楚地显示肠源性囊肿的全貌，当在脊髓腹侧面中线部位硬膜下腔发现一边缘光滑的囊肿．其Tl和T1加权像上信号强度等于或高于脑脊液并伴有其它脊柱畸形时。应高度提示肠源性囊肿的诊断．     

Cervical high-intensity intramedullary lesions in achondroplasia: Aetiology, prevalence and clinical relevance

Objectives

In achondroplastic patients with slight complaints of medullary compression the cervical spinal cord regularly exhibits an intramedullary (CHII) lesion just below the craniocervical junction with no signs of focal compression on the cord. Currently, the prevalence of the lesion in the general achondroplastic population is studied and its origin is explored.

Methods

Eighteen achondroplastic volunteers with merely no clinical signs of medullary compression were subjected to dynamic magnetic resonance imaging (MRI). The presence of a CHII lesion and craniocervical medullary compression in flexed and retroflexed craniocervical positions was explored. Several morphological characteristics of the craniocervical junction, possibly related to compression on the cord, were assessed.

Results

A CHII lesion was observed in 39% of the subjects and in only one of these was compression at the craniocervical junction present. Consequently, no correlation between the CHII lesion and compression could be established. None of the morphological characteristics demonstrated a correlation with the CHII lesion, except thinning of the cord at the site of the CHII lesion.

Conclusions

CHII lesions are a frequent finding in achondroplasia, and are generally unaccompanied by clinical symptoms or compression on the cord. Further research focusing on the origin of CHII lesions and their clinical implications is warranted.

Key Points

? MRI now reveals exquisite detail of the cervical spinal cord. ? Cervical cord lesions are observed in one third of the achondroplastic population. ? These lesions yield high signal intensity on T2 weighted MRI. ? They are generally unaccompanied by clinical symptoms or cord compression. ? Their aetiology is unclear and seems to be unrelated to mechanical causes.     

Magnetic resonance imaging in a juvenile type of distal and segmental muscular atrophy of the upper extremities

Eight patients with a juvenile type of distal and segmental muscular atrophy of the upper extremities (DSMA), a type of cervical flexion myelophathy, were evaluated using MR imaging. In the neutral position there was no spinal cord compression, but in flexion the spinal cord was displaced anteriorly and was compressed by the posterior surfaces or margins of the vertebrae and/or any herniated disks in all cases. In flexion, compression of the cord was exaggerated in seven patients by the anterior displacement of the posterior margin of the thecal sac, which was accompanied by dilated posterior internal vertebral veins. In patients suspected of having DSMA, MR images made in flexion are regarded essential for verifying the diagnosis. Correspondence to: K. Hasuo     

Importance of absence of CSF pulsation artifacts in the MR detection of significant myelographic block at 1.5 T

MR imaging was performed on 21 patients who had high-grade myelographic block due to various diseases in all spinal compartments (extradural, intradural/extramedullary, and intramedullary) and in all portions of the spinal canal (cervical, thoracic, and lumbosacral). Loss of CSF pulsation artifacts due to significant compression of the spinal cord was demonstrated on non-motion-compensated T2-weighted examinations in each case. We believe that the absence of such artifacts on these sequences indicates significant spinal cord compression in patients without classic signs and symptoms of cord compression but with intraspinal disease identified on T1-weighted studies.     

上颈椎疾病手术方法选择

 目的 分析上颈椎疾病的病因、寰枢椎复位和脊髓受压情况,探讨上颈椎疾病的手术方法选择.方法 2003-01至2007-06收治169例上颈椎疾病,根据病因分为:上颈椎骨折74例,先天性上颈椎疾病65例,肿瘤21例,其他病因导致寰枢椎不稳9例.根据病因、寰枢椎复位情况和脊髓受压情况分别采用前路手术、后路手术或者前后路手术.结果 28例可复位齿状突骨折患者采用前路空心螺钉内固定.97例上颈椎可复位,脊髓前方无明显受压患者采用单纯后路复位内固定,取自体松质骨植骨融合.44例难复位或脊髓前方明显受压患者采用前路减压、复位,后路内固定、取自体松质骨植骨融合.结论 根据上颈椎疾病病因、复位和脊髓受压情况,应分别选择前路、后路或者前后路联合手术治疗.     

Ⅰ期前后路联合手术治疗颈髓前后方同时受压

目的 探讨颈髓前后方同时受压Ⅰ期前后路手术的方法。方法 总结1999年6月～2003年11月收治的25例颈髓前后方同时受压的临床资料。男18例，女7例；年龄28～56岁，平均36．4岁。交通伤致颈椎三柱骨折18例，嵌夹型颈椎病5例，椎体和附件、椎板恶性巨细胞瘤2例。结果 25例均行Ⅰ期前后路联合手术减压内固定，创伤患者术后l例死亡，17例有不同程度恢复；颈椎病患者症状和阳性体征基本消失；肿瘤患苫疼痛基本消失，其中1例出现肺转移。结论 对各种原因引起颈髓前后方同时受压的患者，Ⅰ期前后路联合手术是理想方法，可使严重颈椎骨折脱位患者彻底解除颈髓压迫，损伤节段获得早期稳定，方便护理和功能锻炼，有利于脊髓功能恢复。     

慢性压迫性脊髓损伤后骨骼肌退变与再生的实验研究

目的：观察慢性压迫性脊髓损伤后骨骼肌形态学改变及其成肌细胞的增殖动力学变化。方法：50只Wistar雌性大鼠，随机分为正常组（10只）、假手术组（10只）和慢性压迫组（30只）。慢性压迫组置入平头塑料螺钉对大鼠脊髓进行后路渐进性压迫，于2个月后分别压迫至20％（10只）、40％（10只）、60％（10只）左右。处死大鼠后取腓肠肌，分别做HE染色和制成细胞悬液备用。用图像分析仪测定肌细胞直径及截面积，用流式细胞仪对成肌细胞的细胞周期进行分析。结果：各压迫组的大鼠腓肠肌细胞萎缩、退变，其直径变细及截面积变小，随压迫程度的加重而越发明显（P＜0．05）；压迫组较正常组成肌细胞S期细胞增多，G2／M期细胞减少（P＜0．05）。结论：脊髓压迫性损伤可引起靶器官肌肉的退变，其退变的程度与脊髓受压程度呈正相关。虽然同时存在骨骼肌的增殖反应，但完整的细胞分裂过程少见，这可能是慢性压迫性脊髓损伤后影响功能恢复的原因之一。     

Primary disorders of bone with 'spinal block'.

Two hundred and thirty-two cases of compression of the spinal cord or cauda equina included 11 cases where compression was entirely due to a primary bony disorder and 20 further cases where developmental spinal stenosis was the main cause of compression. The former group consisted of two cases of Paget's disease and one each of polyostotic fibrous dysplasia, chondrosarcoma, achondroplasia, spondylo-epiphyseal dysplasia, Klippel--Feil syndrome, haemangioma of bone, primary bone reticulosarcoma, osteoporotic fracture and vertebral osteomyelitis. Three patients, with fibrous dysplasia, chondrosarcoma and Paget's disease with recurrent compression respectively, are described and the relevant literature is reviewed. The large number of primary disorders of bone which can cause cord compression are tabulated. Cord compression is a rare complication in most of these disorders but collectively they caused 13% of the cases of spinal block in this series.