脊髓型鞭击损伤综合征的MR诊断

目的 认识脊髓型鞭击损伤综合征的MR影像表现。方法 本文从数百例脊椎外伤，选择最后诊断为脊髓鞭击损伤综合征的21例MR资料做回顾性分析(均进行轴位T2、矢状位T1wI和T2wI扫描，部分加冠状T2wI扫描)。结果 MR检查能安全迅速客观地反映脊髓损伤程度，推测判断预后。结论 MR检查是脊髓鞭击损伤综合征的首选检查方法；早期确诊，对临床早期治疗、早期康复有其不可估量的临床意义和特殊价值。     

Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

BACKGROUNDTuberculous myelitis is a rare manifestation of tuberculosis (TB) that is usually caused by hematogenous spread of Mycobacterium tuberculosis (MTB). Neurosyphilis is a neurological disease that occurs when Treponema pallidum invades the brain or the spinal cord. Individually, these two diseases involving the spinal cord are rare and cases of concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis have seldom been reported.CASE SUMMARYA 56-year-old man presented with numbness and pain of both lower limbs for 2 wk and dysuria for 1 wk. Syphilis serology and cerebrospinal fluid (CSF) analysis supported the diagnosis of neurosyphilis and the patient was treated with intravenous ceftriaxone at first, but symptoms still progressed. Then, magnetic resonance images revealed multiple lesions along the cervicothoracic junction, and chest computed tomography showed a typical TB lesion. MTB DNA was detected in the CSF sample by metagenomic next-generation sequencing. Eventually the patient was diagnosed with tuberculous myelitis combined with asymptomatic neurosyphilis. Subsequently, quadruple anti-TB drug standardized therapy was empirically used and his neurological symptoms improved gradually. CONCLUSIONPatients can have coinfection with tuberculous transverse myelitis and asymptomatic neurosyphilis. Patients with neurosyphilis should be examined for other pathogens.     

下段颈椎脊椎功能单位活动度与椎管狭窄程度间相关性分析

目的：探讨退变性下段颈椎的脊椎功能单位（FSU）活动度与相应节段椎管狭窄程度间相关性。资料与方法：随机选取拟行手术治疗的脊髓型颈椎病病人62例。全部拍摄MRI及动力位（过伸-过屈位）颈椎侧位CR片。测量参数包括C2~C7过伸/过屈位Cobb角和,反映颈椎整体活动度;选取C3~C4、C4~C5、C5~C6三个水平的颈椎FSU过伸/过屈位Cobb角和表示FSU的节段性活动度。依据椎管狭窄等级（Ⅰ、Ⅱ、Ⅲ级）,分别对该3个FSU活动度行统计学分析。结果：Ⅰ级椎管狭窄病人的C4~C5、C5~C6椎间活动度大于C3~C4水平,其中C4~C5、与C3~C4水平间显示统计学差异。C4~C5、椎间活动度在Ⅲ级椎管狭窄时显著降低,与Ⅰ级、Ⅱ级有统计学意义。8例未显示Ⅲ级椎管狭窄病人与54例Ⅲ级椎管狭窄病人的椎体整体活动度间差异无统计学意义。结论：颈椎FSU作为维持颈椎稳定性的基本单元,随着椎管狭窄程度的增加稳定性增加,但却以牺牲椎管空间为代价,出现椎管狭窄,联合应用动力位CR侧位片及MR检查在判定颈椎活动度与椎管狭窄程度间关系显示重要价值。     

Tethered cord syndrome: a pediatric case study

Tethered cord syndrome, seen in patients with spinal dysraphism, is a progressive neurological deterioration due to stretching of the spinal cord. Spinal dysraphism results from defects during embryonic closure of the neural tube, usually in the lumbosacral region. In tethered cord syndrome an abnormally low conus medullaris is tethered by intradural abnormalities such as a short, thickened filum terminale, fibrous bands, a lipoma or diastematomyelia. This article distinguishes tethered cord syndrome from other forms of occult spinal dysraphism and describes and compares normal anatomy to pathological changes. Clinical symptoms and nursing management of the pediatric patient with tethered cord syndrome will be exemplified by a case study presentation.     

适合MRI研究的羊颈髓压迫损伤模型的制作

目的 探讨建立一种新的适合MRI研究的羊颈髓压迫损伤模型.方法 健康山羊10只,体重20～25 kg,随机分为实验组和对照组.手术显露左侧颈2-3椎间孔,将自制的导管球囊通过椎间孔插入硬膜外腔,达颈2-3椎间盘水平.实验组术后第10天经导管缓慢注射生理盐水0.2 ml使球囊膨胀.持续压迫40天.对照组不注水.利用MR、运动功能评分和病理学检查对模型进行评价.结果 置入的球囊位于脊髓的左前方.球囊未注水时,球囊所在部位蛛网膜下腔变窄,脊髓没有明显受压.注水0.2 ml后,球囊呈椭圆形,脊髓受压变扁.所有MR图像显示清楚,没有明显伪影.实验组运动功能评分下降,病理学检查示神经细胞和神经纤维肿胀、变性、坏死.结论 采用经颈椎椎间孔置入导管球囊制作羊颈髓压迫损伤模型,压迫程度、压迫速度和持续时间可控,保留了椎管的完整性,能获得较满意的MR图像.     

慢性颈脊髓压迫模型大鼠构建及评价

背景：在脊髓型颈椎病脊髓损伤发生机制的研究过程中,建立稳定且同人类体内疾病演变过程相似的疾病模型对于研究脊髓型颈椎病发病机制至关重要。目的：构建慢性颈脊髓压迫模型,观察该模型病理生理变化特点,进一步明确脊髓型颈椎病受压脊髓组织的病理改变。方法：30只SD大鼠随机均分为对照组、轻度压迫组、重度压迫组。将不同大小吸水性压迫材料聚乙烯醇丙烯酰胺互穿网络水凝胶植入C5-C7椎板下,制作慢性颈脊髓压迫动物模型,对照组不植入压迫材料。结果与结论：MRI检查显示两压迫组大鼠出现不同程度的椎管狭窄和脊髓压迫,而对照组椎管宽度正常无脊髓压迫。电生理检测显示两压迫组大鼠运动诱发电位潜伏期较对照组明显延长且振幅明显降低（P〈0．05）。神经元免疫荧光染色显示对照组大鼠脊髓有大量形态规则的神经元,而两压迫组大鼠神经元计数明显减少且神经元胞体形态明显皱缩,脱髓鞘现象明显,3组间比较差异有显著性意义（P〈0．05）。压迫组大鼠脊髓压迫节段发现较多凋亡细胞,而对照组未发现。说明构建的大鼠慢性颈脊髓压迫模型符合脊髓型颈椎病的病理改变,且手术操作简便,不易感染死亡率低;神经元损伤、脱髓鞘改变和凋亡机制参与了大鼠慢性颈脊髓压迫损伤的发生发展过程。     

Sonography for detection of spinal dermal sinus tracts.

OBJECTIVE: It is well known that spinal dysraphism may be complicated by meningitis as a result of infection traveling from the skin along a patent dermal sinus tract. The only clue is the lower back cutaneous lesions. Our aim was to investigate the correlation between cutaneous lesions, patent dermal sinus tracts, and spinal dysraphism and their complications. METHODS: Five patients (3 female and 2 male) with spinal patent dermal sinus tracts were studied. We used a 7-MHz linear transducer with a two-dimensional real-time sonographic system to insonate and obtain transverse and longitudinal views of the spinal cord and subcutaneous area, extending from the cervical cord to the sacral areas. Subsequently, we performed spinal magnetic resonance imaging in every patient to confirm the diagnosis and to evaluate the intraspinal conditions. RESULTS: The associated central nervous system anomalies and complications were tethered cords (n = 5), dermoid cysts (n = 3), lipoma (n = 2), central nervous system infections (n = 2), and syringomyelia (n = 1). The outcomes were better in those who received surgical intervention before they were infected. CONCLUSIONS: Early detection of spinal patent dermal sinus tracts and related anomalies was accomplished with spinal sonography and allowed for prophylactic treatment (e.g., early surgical intervention) before the onset of neurologic deficits.     

Orientation entropy analysis of diffusion tensor in healthy and myelopathic spinal cord

The majority of nerve fibers in the spinal cord run longitudinally, playing an important role in connecting the brain to the peripheral nerves. There is a growing interest in applying diffusion tensor imaging (DTI) to the evaluation of spinal cord microarchitecture. The current study sought to compare the organization of longitudinal nerve fibers between healthy and myelopathic spinal cords using entropy-based analysis of principal eigenvector mapping. A total of 22 subjects were recruited, including 14 healthy subjects, seven cervical myelopathy (CM) patients with single-level compression, and one patient suffering from multi-level compression. Diffusion tensor magnetic resonance (MR) images of the cervical spinal cord were obtained using a pulsed gradient, spin-echo echo-planar imaging (SE-EPI) sequence with a 3T MR system. Regions of interest (ROIs) were drawn manually to cover the spinal cord, and Shannon entropy was calculated in principal eigenvector maps. The results revealed no significant differences in orientation entropy values along the whole length of cervical spinal cord in healthy subjects (C2-3: 0.73±0.05; C3-4: 0.71±0.07; C4-5: 0.72±0.048; C5-6: 0.71±0.07; C6-7: 0.72±0.07). In contrast, orientation entropy values in myelopathic cord were significantly higher at the compression site (0.91±0.03), and the adjacent levels (above: 0.85±0.03; below: 0.83±0.05). This study provides a novel approach to analyze the orientation information in diffusion MR images of healthy and diseased spinal cord. These results indicate that orientation entropy can be applied to determine the contribution of each compression level to the overall disorganization of principal nerve tracts of myelopathic spinal cord in cases with multi-level compression.     

慢性脊髓压迫及减压后骨骼肌细胞凋亡的实验研究

目的:研究大鼠慢性压迫性脊髓损伤及减压后骨骼肌萎缩与细胞凋亡的关系以及凋亡相关基因P53的表达意义。方法:45只SD大鼠分成3组,压迫组15只,作成轻、中和重度慢性脊髓压迫损伤;减压组25只,将重度压迫组的压迫装置取出;正常对照组5只,不做任何处理。应用苏木精-伊红染色、终末脱氧核苷酰转移酶介导的原位末端标记法和原位杂交技术研究慢性脊髓压迫及减压后肌细胞萎缩、凋亡的特点。结果:随着压迫程度的增加肌细胞凋亡数量增加,P53mRNA表达增高;减压后肌细胞凋亡数量明显减少,P53mRNA表达减少。结论:慢性脊髓压迫后肌细胞出现凋亡,骨骼肌细胞的凋亡是肌肉失神经萎缩的机制之一,减压可通过抑制细胞凋亡阻止肌肉萎缩。     

颈椎后纵韧带骨化压迫脊髓的影像学表现

目的研究分析了颈椎后纵韧带骨化压迫脊髓的影像学表现。方法回顾性分析了５７例病人的临床表现和影像学表现。结果颈椎后纵韧带骨化多发生于中老年人,临床出现脊髓受压表现;影像学表现为在椎管前方沿椎体后缘分布的条带状影,致椎管狭窄,压迫脊髓。结论颈椎后纵韧带骨化发展的结果是椎管狭窄,压迫脊髓,出现神经功能障碍     

影像学诊断脊柱骨折相互意义的研究

目的：对比X线、CT及MR在脊柱骨折诊断中的作用及优势与不足。材料与方法：对89脊柱外伤后有临床症状并MR上异常信号改变患者影像资料比较分析。结果：X线平片在显示椎体压缩程度、椎体后突成角及椎体移位方面有优势;CT在显示椎体、椎板、小关节、椎管狭窄方面明显优于X线平片,MRI在显示脊髓受压及脊髓损伤方面明显优于其它检查方法。结论：X线平片作为初步筛选的诊断,CT及MR检查是主要手段,三者相结合才能提高对脊柱骨折的全面诊断。     

脊髓空洞的MRI诊断与鉴别诊断

目的分析18例各种原因所致脊髓空洞的MRI表现及鉴别诊断。方法18例脊髓空洞病例，全部病例经手术或治疗随访证实。MRI重点观察脊髓及其空洞的形态和信号特征。结果18例脊髓空洞中，脊髓肿瘤性空洞7例、Chiari畸形所致5例、创伤后空洞4例、自发性脊髓空洞2例；空洞累及颈或胸髓，空洞均位于脊髓中央管，范围从2～13个脊髓节段不等，空洞内信号变化同脑脊液。但不同原因的空洞又有各自不同的合并症或特点。结论脊髓空洞主要由于脊髓肿瘤、Chiari畸形、创伤、自发性脊髓空洞等引起，不同病因空洞的MRI表现各不相同，据此可进行鉴别诊断。     

Tandem spinal stenosis: a case of stenotic cauda equina syndrome following cervical decompression and fusion for spondylotic cervical myelopathy

Tandem spinal stenosis is a clinical phenomenon which may cause a functional loss related to neurologic compression in numerous areas of the spinal cord. In this phenomenon, the second area of symptomatic neurologic insult is not revealed until the primary symptomatic area has been treated. This case describes a 71-year-old male referred to physical therapy 4 weeks following a combined anterior/posterior C3/4 decompression and fusion for treatment of cervical spondylotic myelopathy. Approximately 8 weeks post-operatively (4 weeks after initiation of physical therapy), the patient began to complain of bilateral lower extremity weakness, primarily with climbing stairs. At 12 weeks post-operatively, the patient developed bowel incontinence and saddle paresthesia. Magnetic resonance imaging revealed multiple levels of critical stenosis of the lower thoracic and upper lumbar spine, which resulted in referral for surgical intervention. Following surgical decompression there was complete recovery of lower extremity strength, saddle area sensation and bowel function. This case highlights the need for the clinician to remain vigilant for concomitant pathology despite successful surgical intervention. A thorough knowledge of the presentation of various spinal disorders, as well as a thorough neurologic examination, is required to accurately recognize both candid and subtle red flags requiring immediate referral for surgical intervention.     

纳洛酮对急性颈髓损伤后血浆及脑脊液中内皮素、降钙素基因相关肽含量的影响

目的探讨急性颈髓损伤后,纳洛酮对内皮素(ET-1)、降钙素基因相关肽(CGRP)含量的影响。方法用RIA法测定急性颈髓损伤病人血浆及脑脊液中ET-1、CGRP含量,观察纳洛酮对ET-1、CGRP水平及颈髓损伤的影响。结果急性颈髓损伤后血浆及脑脊液ET-1明显升高,CGRP明显下降,经纳洛酮治疗组ET-1较创伤组明显下降,而CGRP明显升高。结论急性颈髓损伤后神经元坏死可能与ET-1水平升高,CGRP明显下降有关,纳洛酮可通过降低ET-1水平、提高CGRP水平而发挥对脊髓神经元的保护作用。     

Cerebral blood flow measurement by color velocity imaging in radiation-induced carotid stenosis.

OBJECTIVE: To show whether there is any association between the development of neurologic symptoms and the total cerebral blood flow volume documented by color velocity imaging in patients with carotid stenosis that develops after radiotherapy. METHODS: Twenty-three patients with nasopharyngeal carcinoma (4 female and 19 male; age range, 39-69 years; mean age, 55.6 years) and major extracranial carotid stenosis underwent color velocity imaging. In this group, 8 patients had symptoms of a stroke or transient ischemic attack, and the other 15 patients were asymptomatic. The color velocity imaging results in the symptomatic group were then compared with those in the asymptomatic group. RESULTS: The cerebral blood flow in the symptomatic group was significantly lower than that in the asymptomatic group (224.1 +/- 89.0 versus 532.5 +/- 89.0 mL/min; P = .001). CONCLUSIONS: Cerebral blood flow as measured by color velocity imaging was lower in the symptomatic group. There is an association between the development of neurologic symptoms and blood flow volume.     

腰骶椎管闭合不全超声检查的应用

目的 :观察超声在腰骶椎管闭合不全合并脊髓栓系综合征中诊断和术后随访的价值。方法 :6 8例患者进行腰骶椎管超声检查 ,同时有脊髓造影 CT或磁共振 (MRI)确诊并经手术证实进行对比评价 ;对术后 30例随访超声观察。结果 :超声可同样检查 CT或 MRI显示本症的特征 ,低位脊髓、脊髓背移、椎管内脂肪瘤或囊性脊椎裂的病变异常 ;同时超声尚能检查出脊髓远端动态脉跳搏动消失。超声诊断正确率为 85 .3%。术后随访 30例中有 3例可能术后粘连致再栓系。结论 :超声可作为无损伤早期初筛诊断 ,尤为可疑婴幼儿和儿童的应用 ,并可术后随访     

Development and validation of retrospective spinal cord motion time-course estimates (RESPITE) for spin-echo spinal fMRI: Improved sensitivity and specificity by means of a motion-compensating general linear model analysis

Cervical spinal cord displacements have recently been measured in relation to the cardiac cycle, substantiating that cord motion in this region reduces both the sensitivity and reproducibility of functional magnetic resonance imaging of the spinal cord (spinal fMRI). Given the ubiquitous and complex nature of this motion, cardiac gating alone is not expected to sufficiently remove these errors, whereas current modeling approaches for spin-echo methods are not specific to motion artifacts, potentially eliminating function-related data along with components of motion-related noise. As such, we have developed an alternative approach to spinal cord motion-compensation, using retrospective spinal cord motion time-course estimates (RESPITE) to forecast a small number of physiological noise regressors. These are generated from the principal components of spinal cord motion, as well as subject-specific cardiac data, and are subsequently included in a general linear model (GLM) analysis. With this approach, the components of motion-related signal fluctuation are modeled, along with functionally-relevant signal changes (i.e., those components fitting the stimulus paradigm), to account for the effects of spinal cord and cerebrospinal fluid (CSF) motion in a thorough, yet discerning, manner. By analyzing 100 previously acquired half-Fourier turbo spin-echo (HASTE) spinal fMRI data sets, along with a collection of null-task data, we show that the implementation of RESPITE reduces the occurrence of both type I (false-positive) and type II (false negative) errors, effectively increasing the specificity (5-6%) and sensitivity (15-20%) to neuronal activity.     

Intra-spinal new bone formation and spinal cord compression in familial hypophosphataemic vitamin D resistant osteomalacia

Four patients with familial hypophosphataemic vitamin D resistant osteomalacia and spinal cord compression are reported. Three of these patients were treated by decompressive laminectomy and each made a good recovery. At surgery new bone formation in the ligamentum flavum and thickening of laminae were found to be responsible for the canal stenosis and cord compression. Two of these four patients, and 10 others were examined by computed tomography to determine the incidence, site and extent of any intra-spinal new bone formation. Facet joint hypertrophy and thickened laminae were observed at some level in all the patients, but much the most important cause of spinal canal stenosis was new bone formation in the ligamentum flavum, in the mid and lower thoracic spine, occurring at several, but mainly contiguous vertebral levels. Severe spinal canal stenosis was found in eight of the 12 patients scanned. No obvious relation was found between the presence of intra-spinal new bone formation and the clinical severity of the disease or the presence of extra-skeletal ossification in para-spinal and other sites. Computed tomography offers a simple, non-invasive technique for identifying those patients at risk of cord compression from new bone formation.     

脊髓损伤的弥散张量成像研究进展

MR DTI作为目前唯一能显示水分子运动方向和强度的成像技术,可以动态反应中枢神经系统白质的超微结构及相应病理生理改变,为研究脊髓损伤提供了新的方法。近年来脊髓DTI已应用于临床。本文对脊髓DTI技术的应用、发展趋势进行综述。