急性横贯性脊髓炎的临床及MRI特征分析

目的探讨急性横贯性脊髓炎(ATM)首次发作的临床及MRI影像特征。材料与方法回顾性分析我院2006年7月至2012年7月间56例急性横贯性脊髓炎患者首次发作的临床、MRI影像学特征(至少2年的随访结果以协助最终诊断)。结果 (1)56例ATM患者首次发作后必须至少1次随访并随访时间超过2年,临床确诊为:多发性硬化(MS)19例(19/56,33.9%),视神经脊髓炎(NMO)10例(10/56,17.9%),系统性自身免疫性疾病3例(3/56,5.4%),类感染病因4例(4/56,7.1%),特发性横贯性脊髓炎20例(20/56,35.7%)。(2)所有患者均有脊髓病变平面以下不同程度的运动、深浅感觉及自主神经功能障碍。(3)MRI特征:颈髓18例,胸髓17例,颈胸髓受累13例,胸腰髓受累8例;33例病变脊髓轻度肿胀,23例脊髓形态未见异常;病灶平均长度为4.7个脊髓节段,病灶占据脊髓2/3以上横断面积29例,27例占据面积小于脊髓横断面的2/3;15例脊髓病变区无强化,41例病变区呈条状、斑片状等强化。结论结合临床和MRI影像特征,有利于ATM的诊断和鉴别诊断。

Analysis of the clinical and MRI characteristics in patient with acute transverse myelitis

AbstractObjective:To study the clinical and MRI characteristics of acute transverse myelitis (ATM) after the onset of symptoms.Materials and Methods:The clinical information and MRI features of 56 cases with ATM during Jul.2006~Jul.2012 were analyzed retrospectively, and all patients with a follow-up duration longer than 2 years were identified.Results:(1) Fifty-six cases of ATM patients must have had at least one follow-up visit more than 2 years after the onset of symptoms. 19 cases(33.9 %, 19/56) for multiple sclerosis (MS), 10 cases(17.9%, 10/56) for neuromyelitisoptica (NMO), 3 cases (5.4%, 3/56) for systemic autoimmune disease,4 cases(7.1%, 4/56) for parainfectious and 20 cases (35.7%, 20/56) foridiopathic were clinically deifned. (2) All patients had varying degrees of motor, sensory and autonomic dysfunction below the level of the cord lesions. (3) MRI features: The cervical cord was involved in 18 cases.The thoracic cord was involved in 17cases.The cervical and thoracic spinal cord was all involved in 13 cases.The thoracic and lumbar spinal cord was involved in 8 cases. Thirty-three cases of lesions were associated with swelling, and in other 23 cases the spinal cord showed normal appearance. The average lesion length was 4.7 spinal segment, 29 cases were involved more than two-thirds of the cross-sectional area of the spinal cord, 27 cases occupied less than two-thirds of the cross-sectional area. Contrast-enhanced MR scanning demonstrated that non-enhancement was seen in 15 cases, patchy or strip enhancement were revealed in 41 cases. Conclusions:The combination of clinical characteristics and MRI featurescan improve the diagnosis and differential diagnosis with ATM.