结核性脊髓脊膜炎的MRI诊断价值

目的：探讨MRI对结核性脊髓脊膜炎的诊断价值。方法：对21例结核性脊髓脊膜炎增强前后的MRI进行回顾性分析。结果：所有21例MRI平扫均可见脊膜受累,主要表现为脊膜不规则增厚,蛛网膜下腔狭窄或闭塞、分隔样改变、囊肿形成,神经根增厚;增强扫描表现为增厚的脊膜呈线状、斑块状、结节状和环状强化。本组21例中脊髓肿胀17例,脊髓空洞6例,髓内结核瘤5例。结论：MRI平扫和增强扫描可清晰显示结核性脊髓脊膜炎的病变部位和累及范围,可为临床治疗及判断预后提供影像学参考。     

原发性椎管内肿瘤的MRI诊断价值

目的：评价ＭＲＩ对原发性椎管内肿瘤的诊断价值。材料和方法：对６３例原发性椎管内肿瘤进行ＭＲＩ扫描，并与手术病理和临床随访结果对照分析。结果：检出神经纤维瘤及神经鞘瘤２７例，脊膜瘤１１例，髓内胶质瘤１４例，蛛网膜囊肿６例，皮样囊肿２例，淋巴瘤２例，脂肪瘤１例。与ＣＴ和脊髓造影等检查相比，ＭＲＩ对本病的检出率和诊断正确率明显提高。结论：ＭＲＩ是发现原发性椎管内肿瘤的首选方法，对本病的诊断与鉴别诊断具有重要价值。     

椎管内肿瘤的MRI表现

目的：评价ＭＲＩ诊断椎管内肿瘤的价值。材料与方法：回顾性分析７５例经手术嵛 证帝的椎管内肿瘤的ＭＲＩ表现。结果：髓内肿瘤２０例。室管膜瘤两端有性改变,瘤体边界清楚,囊壁转移及瘤体增强明显。胶质瘤边界不清,脊髓水肿明显,有点状及絮状增强。髓外肿瘤５５便。神经源性肿瘤及脊膜瘤均有清楚界有者可呈哑铃状生长,中央部分不增强,可呈多房性。后者增强较均匀,靠近脊膜侧呈宽基底,脂肪瘤呈特殊的Ｔ１ＷＩ高信号,Ｔ２     

结核性脑膜炎神经系统损害的MRI诊断

目的 探讨ＭＲＩ在诊断结核性脑膜炎神经系统损害中的价值。材料与方法 对５３例经手术或临床证实的结核性脑膜炎患者进行ＭＲＩ检查,获取头部矢状位Ｔ１ＷＩ、横断位Ｔ１ＷＩ及Ｔ２ＷＩ,部分病例加作颈胸段ＭＲＩ。所有患者均进行Ｇｄ－ＤＴＰＡ增强检查。结果 硬脑膜增厚、脑池及脑沟闭塞４０例,脑血管炎及脑梗塞２８例,脑结核球１２例,脑积水１６例,脑萎缩２３例,视交叉及视神经损害２例,脊膜、脊髓损害４例。结论 Ｍ     

颅内结核性脑膜炎的MRI诊断

目的 评估ＭＲＩ对颅内结核性脑膜炎的诊断价值。材料与方法 对１８例颅内结核怀脑膜炎的ＭＲＩ表现、Ｇｄ－ＤＴＰＡ增强的作用和追踪ＭＲＩ的变化进行分析。结果 ＭＲＩ显示脑膜炎１３例,表现为蛛网膜腔狭窄和消失,脑脊液分房。在增强ＭＲＩ上,受累的脑膜呈线形、弥漫性斑块和结节状或环状显著性强化。结核性脑膜炎合并结核瘤２例,结核性脑脓肿２例,脑梗塞１例。结论 结核性脑膜炎的ＭＲＩ表现有一定的特点,增强ＭＲＩ可     

中枢神经系统结核的CT及MRI诊断

本文报道了６７例中枢神经系统结核的ＣＴ及ＭＲＩ表现，其中结核性脑膜炎３８例，脑结核瘤１８例，结核性脑膜炎合并结核瘤５例、合并脊髓蛛网膜炎６例。头颅ＣＴ对病变显示率为８４．６％，病损类型有基底池渗出物、脑积水、结核瘤、脑梗塞、脑萎缩及基底池钙化等。增强ＣＴ扫描应列为常规检查。４例结核性脊髓蛛网膜炎ＭＲＩ扫描，显示蛛网膜下腔闭塞消失、髓内外结核瘤、脊髓受压或肿胀及晚期空洞形成，此类影像表现既往国内文献无系统报道。ＣＴ及ＭＲＩ各有长短，其定性价值仍需密切结合临床及脑脊液检查     

椎管内肿瘤的MRI表现(附75例分析)

目的：评价ＭＲＩ 诊断椎管内肿瘤的价值。材料与方法：回顾性分析７５ 例经手术及病理证实的椎管内肿瘤的ＭＲＩ 表现。结果：髓内肿瘤２０ 例。室管膜瘤两端有囊性改变,瘤体边界清楚,囊壁转移及瘤体增强明显。胶质瘤边界不清,脊髓水肿明显,有点状及絮状增强。髓外肿瘤５５ 例。神经源性肿瘤及脊膜瘤均有清楚界限,前者可呈哑铃状生长,中央部分不增强,可呈多房性。后者增强较均匀,靠近脊膜侧呈宽基底。脂肪瘤呈特殊的Ｔ１ ＷＩ 高信号,Ｔ２ＷＩ 为灰色。血管脂肪瘤Ｔ１ＷＩ 呈高信号,增强后采用抑脂（ＦＡＴＳＡＴ） 序列扫描呈高信号。脊索瘤为骶尾段自椎骨向椎管内生长,破坏的骶骨呈长Ｔ１ 和长Ｔ２ 信号。髓母细胞瘤骶管内种植转移灶上缘呈结节状,信号不均匀。结论：ＭＲＩ 结合ＧｄＤＴＰＡ增强扫描,对椎管内肿瘤的定位及定性诊断具有重要价值。     

脊髓血管畸形的MRI诊断(附3例报告及文献复习)

目的：评价ＭＲ成像对脊髓血管畸形的诊断价值。方法：共３例，其中２例为硬脊膜动静脉瘘，１例为根脊膜血管畸形，在１．５Ｔ磁共振机上应用表面线圈作高分辨ＭＲ成像，其结果与选择性脊髓动脉造影进行对照。结果：ＭＲ不仅可显示畸形血管特征性的快速流空现象，而且还可显示畸形血管远端髓内长Ｔ１、长Ｔ２信号改变。ＭＲＩ与血管造影结果基本符合。结论：ＭＲ成像是评价脊髓血管畸形十分敏感和有效的方法     

颈髓动静脉畸形的临床和影像诊断

文中报道７例经选择性脊髓动脉造影或／和ＭＲＩ证实的颈髓动静脉畸形（ＣＳＡＶＭ），着重分析其临床和影像特点。其中２例行手术治疗，１例经血管内栓塞。４例突发起病，临床症状和体征以及脑脊液检查诊断蛛网膜下腔出血（ＳＡＨ），脑ＣＴ和颈动脉造影正常。４例病变位于髓内，３例以髓外为主，髓内也受累。５例行ＭＲＩ检查均明确显示病变的部位和范围，１例可见异常血管团内的慢性出血灶以及位于颈髓背侧呈锯齿状向头侧引流的静脉。ＭＲＩ检查可作为ＣＳＡＶＭ确诊的方法，但对拟行手术和血管栓塞治疗的患者行选择性脊髓动脉造影是必要的。上颈段动静脉畸形主要由颅内段椎动脉分支供血，血管栓塞和手术治疗较下颈段困难和危险。     

结核性脊膜脊髓炎的MRI诊断

目的 探讨结核性脊膜脊髓炎MRI表现,提高其诊断准确性. 资料与方法 回顾性分析经手术后病理证实或诊断性用药后疗效显著的10例结核性脊膜脊髓炎的MRI表现特点. 结果 10例MRI平扫,7例脊髓内呈结节状、串珠状、条带状异常信号;3例蛛网膜下腔充填稀薄的异常信号;3例脊膜增厚;2例硬膜外见条状异常等信号;3例合并椎体及附件结核伴椎旁冷脓肿;1例合并脑干内多发小结节影;5例MRI增强扫描,4例脊膜增厚强化,2例脊髓内斑点状中度强化,1例脊髓内环状强化. 结论 MRI对结核性脊膜脊髓炎的临床诊断具有重要价值.     

Comparison of MR and CT myelography in imaging the cervical and thoracic spine

MR imaging and CT myelography were compared in a retrospective study of 38 patients with suspected lesions of the cervical and thoracic spinal canal and cord. Twenty-eight abnormal cases were found, including spondylosis (9), tumors (8), intramedullary cavities (3), arachnoiditis (3), disk-space-centered infection or osteomyelitis (2), nonneoplastic cord swelling (2), and CSF-borne metastasis (1). MR was equal or superior to CT myelography in depicting cases of cord enlargement, cord compression, and cord atrophy, providing better tissue characterization, no shoulder artifact, and no limitation caused by CSF block. CT myelography was superior to MR in depicting cases of spondylosis and arachnoiditis. It showed superior spatial resolution, which was most pronounced when comparing axial images and hence particularly superior in detecting the lateral extent of disk herniation. Use of surface coils and thin imaging sections is essential for accurate and complete MR evaluation of the cervical and thoracic spine.     

Role of FIESTA combined with conventional MRI in the evaluation of traumatic brachial plexus roots injury

Purpose

Purpose was to evaluate the role of Fast imaging employing steady-state acquisition (FIESTA) together with conventional MR sequences in the evaluation of traumatic brachial plexus roots injury compared to post contrast MR and Spin Echo MR myelographic studies.

Patients and methods

In this prospective study, 16 patients with a mean age of 17.9 y who presented with traumatic brachial plexus roots injury in motor cycle and car accidents were studied with FIESTA, conventional MR, post contrast MR and MR myelography sequences. Imaging findings included: pseudo-meningocele/hemorrhage near the nerve root exit, failure of visualization of the nerve root (dorsal, ventral or both), retracted avulsed nerve root ends, spinal cord edema, and para spinal muscles edema and hemorrhage. Diagnostic accuracy was calculated for each MR sequence. Imaging findings were compared with the gold standard operative findings.

Results

FIESTA combined with conventional MR depicted pseudomeningoceles, non visualized nerve roots, cord displacement, and para spinal muscles abnormalities in 15 patients (93.8%), cord edema in four patients (25%). Pre and post contrast MR detected pseudomeningoceles and non visualized nerve roots in 13 patients (81.3%) while Spin Echo myelography detected pseudomeningoceles and non visualized nerve roots in 14 patients (87.5%). FIESTA combined with conventional MR showed the highest diagnostic accuracy (93.8%) compared to pre and post MR (81.3%) and Spin Echo myelography (87.5%).

Conclusion

It is crucial to differentiate between preganglionic and postganglionic injuries for optimal treatment planning in patients with BPI. Conventional MR imaging yielded suboptimal information regarding the fine details of nerve roots’ injury. MR myelography showed some artifacts that decreased overall diagnostic accuracy, FIESTA combined with conventional MR depicted nerve segments in greater detail and provided important information about the relationship of the nerves to nearby structures, it provided high contrast resolution between cerebrospinal fluid and solid structures, allowing the reconstruction of elegant multi-planar images that highlight the injured nerves. Contrast study is recommended in mild trauma cases with normal morphological study.     

Asymptomatic spinal arachnoiditis in patients with tuberculous meningitis

Spinal arachnoiditis is one of the common and disabling complication of tuberculous meningitis (TBM). We focused on early diagnosis of spinal arachnoiditis by spinal MRI in asymptomatic patients in whom neurological examination was normal. We studied 16 patients with a diagnosis of probable or highly probable TBM with symptoms for less than 1 month; three had radiological evidence of spinal arachnoiditis. High cerebrospinal fluid protein appeared to be a risk factor for development of spinal arachnoiditis. MRI is sensitive to detect early spinal arachnoiditis. Earlier diagnosis may be helpful in management of spinal arachnoiditis in TBM.     

Midline septa in the lumbo-sacral thecal sac: acquired abnormality or developmental anomaly? The equivalent of diastematomyelia occurring below the spinal cord?

Careful analysis of over 400 patients radiologically diagnosed with arachnoiditis showed a subgroup of eight patients with a specific set of imaging signs that suggest a pre-existing developmental abnormality mimicking the appearance of arachnoiditis. These cases have been collected over a 15-year period. No autopsy or surgical proof is available. All patients have (i) the presence of a well-defined midline septum in the sagittal plane that splits the thecal sac, usually symmetrically, in the lower lumbar or sacral region, below the level of the spinal cord; (ii) the absence of adjacent epidural fibrosis that one would expect if the septation had been caused by surgical intervention or trauma; (iii) the preservation of cerebrospinal fluid within the nerve root sheaths and around the nerve roots at the level of the septation; and in four cases (iv) the presence of either calcification or bone in this midline septum, yet nowhere else in the theca or epidural space. These cases suggest a developmental variant called, for want of a better term, 'split lumbo-sacral thecal sac' analogous to diastematomyelia but not involving the spinal cord. This variant is potentially confused with arachnoiditis or thecal scarring in the lumbo-sacral sac.     

垂体微腺瘤的MR成像(附25例分析)

目的 :探讨MR尤其是增强扫描技术对垂体微腺瘤的诊断价值。材料和方法 :回顾性分析已明确诊断的 2 5例垂体微腺瘤MR增强前、后扫描资料。结果 :增强前 11例显示垂体内低信号或略低信号 (4 4 % ) ,等信号 14 (5 6% )。增强扫描后低信号显示率 88%。标准剂量增强 12例中由增强前显示 7例 (5 8% )低信号上升到 11例 (91% ) ,半剂量法增强 8例均显示垂体内低信号 (10 0 % ) ,非动态增强 5例中 ,3例显示低信号。结论 :MRI对诊断垂体微腺瘤有较高特异性及敏感性 ,动态增强扫描 ,尤其是半剂量法增强应作为诊断垂体微腺瘤常规方法。     

MRI of spinal intradural arachnoid cyst formation following tuberculous meningitis

Secondary intradural arachnoid cyst involving the spine is uncommon. It is usually secondary to trauma, haemorrhage, surgery or inflammation. We present two cases of treated tuberculous meningitis, which presented with gradual onset of quadriplegia and paraplegia, respectively. MRI revealed intradural (cervical and thoracic) arachnoid cysts (ventral and dorsal to the spinal cord) with myelomalacic cord changes. Ventral location of such spinal arachnoid cysts, and being secondary to tuberculous arachnoiditis are distinctively uncommon features. The rarity of this condition and the relevance of MRI in the accurate diagnosis have been discussed here.     

Central nervous system tuberculosis: MRI

The MRI findings of 18 proven cases of central nervous system (CNS) tuberculosis were reviewed; 10 patients were seropositive for HIV. All had medical, laboratory, or surgical proof of CNS tuberculosis. Eleven patients had meningitis, of whom two also had arachnoiditis. Five patients had focal intra-axial tuberculomas: four brain masses and one an intramedullary spinal lesion. Two patients had focal extra-axial tuberculomas: one in the pontine cistern, and one in the spine. In all 11 patients with meningitis MRI showed diffuse, thick, meningeal enhancement. All intraparenchymal tuberculomas showed low signal intensity on T2-weighted images and ring or nodular enhancement. The extra-axial tuberculomas had areas isointense or hypoitense relative to normal brain and spinal cord on T2-weighted images. Although tuberculous meningitis cannot be differentiated from other meningitides on the basis of MR findings, intraparenchymal tuberculomas show characteristic T2 shortening, not found in most other space-occupying lesions. In the appropriate clinical setting, tuberculoma should be considered.