脊髓拴系综合征的MRI表现及临床诊断

目的探讨MRI对脊髓拴系综合征(tethered cord syndrome,TCS)的诊断价值及其临床意义。方法回顾分析12例临床确诊的TCS患者MRI影像学表现,扫描范围包括下胸椎、腰椎、骶椎,常规矢状位、横轴位扫描,9例加扫了冠状位。结果本组12例TCS患者中脊髓圆锥下端低于L1/L2椎间盘水平的12例,脊髓终丝增粗(终丝直径大于3mm)9例,脊髓脊膜膨出7例,椎管内脂肪6例,脊髓空洞4例,脊柱裂4例,腰骶部皮毛窦4例,椎体畸形3例,脊柱侧弯畸形3例。结论 MRI多序列、多方位成像能清晰显示脊髓圆锥的位置、终丝的形态、椎管内外脂肪瘤、脊髓脊膜以及脊柱的各种病理变化,对TCS的临床诊治具有重要意义。

MRI appearance of TCS and its clinical diagnosis

Objective To investigate the the diagnostic value of MRI in the tethered cord syndrome （TCS）, and its clini- cal significance. Methods The MRI imaging performance of 12 patients with clinical diagnosis of TCS were retrospectively analysed in this work. The MRI scanning range included the thoracic, lumbar, sacral, conventional sagittal, axial scanning and 9 cases underwent the coronal scanning. Results In the series, we found that 12 cases were located at less than L1/L2 disc level of the spinae, 9 cases appeared cord end silk thickening （final wire diameter was greater than 3 mm）, 7 cases were the myelomeningocele, 6 cases were the spinal canal fat, 6 cases were syringomyelia, 4 cases were syringomyelia, 4 cases were spina bifida, 4 cases were lumbosacral dermal sinus, 3 cases were vertebral deformity, 3 cases were scoliosis. Conclusion Multiple Sequence of MRI, multi-dimensional imaging can clearly show the location of the conus, the form of the filum terminale, the spinal lipoma of inside and outside, a variety of pathological changes in spinal cord meninges and spine, which is of great significance in the clinical diagnosis and treatment of the TCS.