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。     

长骨恶性纤维组织细胞瘤的MRI诊断

目的 分析长骨的恶性纤维组织细胞瘤MRI表现,以提高对本病MRI影像表现的认识,对临床确定治疗方案提供一定的依据.方法 回顾性分析经手术病理证实的9例长骨原发性恶性纤维组织细胞瘤MRI表现.结果 5例病灶位于股骨远端,1例位于股骨近端,1例为双侧股骨及胫骨多发病变,2例病灶位于胫骨近端,病灶长径3.5～9 cm.均表现为病变区骨质破坏,8例软组织包块形成,肌肉受压、水肿,9例病变均未见骨膜反应.T1WI序列肿瘤呈边界清晰的低信号改变,T2WI和STIR序列髓腔内病变为高、低混杂信号,而软组织肿块信号均较髓腔内病变混杂,其中5例T1WI序列及T2WI序列信号均略高于髓腔内病变,4例病变内见囊变区.结论 MRI扫描对骨恶性纤维组织细胞瘤诊断缺乏特异性,确诊需病理及免疫组化结果.     

鼻腔及鼻窦骨化性纤维瘤的MRI诊断

目的探讨鼻腔、鼻窦骨化性纤维瘤的MRI表现及其诊断价值。资料与方法回顾性分析经手术病理证实的8例鼻腔及鼻窦骨化性纤维瘤患者的MRI资料。结果8例中病变中心位于筛窦3例,蝶窦3例,额窦2例;5例原发病例中4例病变呈膨胀性生长,1例形态不规则呈分叶状;3例术后复发病变的形态均不规则并呈分叶状;所有病变边界均清晰,伴周围结构不同程度受压。骨化性纤维瘤T1WI呈等信号7例(与脑灰质相比),呈低信号1例;T2WI呈低信号7例,其中4例夹杂片状高信号,呈高信号1例;继发囊变者4例,T2WI均呈高信号,T1WI呈等、低信号各2例;增强后病变呈中度强化,囊变部分不强化,而囊壁及间隔明显强化。结论鼻腔及鼻窦骨化性纤维瘤的MRI表现有一定特征性,MRI对观察病变与周围组织结构的关系及手术方案制定有重要临床意义。     

脊髓室管膜瘤的MRI表现

目的探讨脊髓内室管膜瘤的MRI表现,提高对本病的认识。方法收集我院经病理证实的脊髓室管膜瘤13例,分析肿瘤部位、信号特点、有无囊变、出血及帽征、椎间孔扩大及肿瘤强化方式。结果肿瘤位于颈髓6例,胸髓3例,终丝及马尾4例.在T1WI上呈等、低信号,在T2WI上呈高信号、混杂信号.9例见囊变,3例可见肿瘤内出血,2例椎间孔扩大.13例均出现不同程度强化,1例呈轻度强化,3例中度强化,9例重度强化,11例肿瘤与正常脊髓分界清楚。结论髓内室管膜瘤MRI表现具有一定特点,结合其发病部位、边界、囊变、出血、强化特征及临床资料常可作出正确诊断。     

脊柱损伤后上升性截瘫的MRI表现及临床意义:3例报告并文献复习

目的探讨脊柱骨折后上升性截瘫脊髓MRI改变与发生机制的相关性。方法综合回顾分析我们所诊治的3例以及文献报道的14例患者,共17例患者的MRI表现。结果 17例患者于伤后5h～1年不同时间段行28例次MRI。伤后2周以内主要表现为脊髓弥漫性的肿胀;2～4周可见脊髓肿胀逐渐消退;4周以后表现为脊髓萎缩变细。病变主要发生在脊髓中央区,为T2WI信号异常高信号。结论 MRI的临床应用为观察上升性截瘫发生后的脊髓形态信号变化提供了可能,支持了静脉栓塞学说在脊髓损伤后上升性截瘫发病中作用。     

少见部位脑室外神经细胞瘤的MRI影像学表现

目的探讨少见部位的脑室外神经细胞瘤(EVN)的MRI影像表现。资料与方法搜集经病理证实的EVN患者资料共4例,回顾性分析其术前MRI影像表现。结果 4例中,2例位于颈髓,呈囊实性改变,T1WI呈等或稍高信号,T2WI呈稍高信号,1例病灶内可见出血并伴有继发性脊髓空洞;2例位于颅底,均以实性肿块为主,信号欠均匀,T1WI呈稍低信号,T2WI呈稍高信号。4例肿瘤内均可见多发的流空血管。增强后4例肿瘤呈不均匀中～重度强化。结论 EVN MRI表现有一定的特征,鉴别诊断中应考虑该病可能。     

脊髓髓内血管母细胞瘤的MRI特征

目的 研究脊髓血管母细胞瘤的MRI表现及特征,提高术前正确诊断率.资料与方法 回顾性分析35例经手术病理证实的脊髓血管母细胞瘤的MRI表现.结果 MRI上肿瘤可分为两种类型:(1) 囊肿型( 15 例),(2)实体型( 20 例);颈段 26 例,胸段 6 例,腰骶段3例.35例均见脊髓空洞和瘤周水肿,继发延髓空洞者13例.囊肿型肿瘤有典型的囊腔内附壁结节;实体型肿瘤可见较大的边界清楚的肿瘤强化影,部分有血管流空征象.结论 MRI对髓内血管母细胞瘤的定位、定性诊断有重要意义.T2WI能更清晰地显示脊髓空洞的范围,增强T1WI对诊断最具价值 .     

3.0T MR骶神经成像在神经源性膀胱病因探究中的价值

目的:探讨3.0T MR腰骶丛神经成像在探究神经源性膀胱(NB)病因中的价值.方法:回顾性分析119例NB患者的临床和影像资料.结果:影像诊断包括神经根肿瘤69例,骶神经多发异常T2 WI高信号28例,脊髓栓系18例,隐性脊柱裂14例,骶尾部软组织包块3例,神经节细胞瘤2例,神经纤维瘤病1例,骶椎转移瘤1例,骶神经无异常27例.骶神经占位最常发生于S2神经根(62根),其次为S1(41根)、S3(28根)、S4-S5(24根);病变直径≥15 mm者34枚,10～14 mm者36枚,5～10 mm者37枚,≤5 mm者61枚.神经根占位MRI表现为椭圆形T2 WI高信号,T1 WI等信号;脊髓栓系MRI可见骶管内脂肪瘤、圆锥低位和马尾牵拉.骶尾部成熟畸胎瘤表现为T1WI、T2 WI混杂高、低信号;神经节细胞瘤多呈T1 WI低信号、T2 WI高信号.神经纤维瘤病表现为位于脊柱旁的T1WI等信号、T2 WI稍高信号;隐形脊柱裂表现为椎管畸形、棘突及椎板缺损.结论:MRI能准确、直观显示骶丛神经的特征及病灶的数量、位置,有助于NB的诊断、鉴别诊断及规范化治疗.     

磁共振DWI成像技术在脊髓型颈椎病的临床研究

目的：研究扩散加权成像（DWI）在脊髓型颈椎病（CSM）中的应用价值。方法：对26例临床及影像学证实为CSM患者,22例非CSM患者行颈髓MRI和扩散加权成像,分析病变表现并测量其ADC值。结果：48例均获得弥散加权图像和弥散系数。CSM患者受压部位ADC值明显高于邻近部位和正常颈髓ADC值,差异有统计学意义（P〈0.05）;17例CSM脊髓受压部位T2WI出现高信号,ADC值增高;9例T2WI表现为等信号,其中有6例表现为脊髓受压部位ADC值增高,DWI显示不同信号组受压部位平均ADC值差别无统计学意义（P〉0.05）,但不同信号组受压部位与相应邻近正常部位平均ADC值比较,差异有统计学意义（P〈0.05）。结论：DWI可以通过受压脊髓ADC值改变更早的判断脊髓内部变化,比常规T2WI能更早、更准确显示脊髓受压的情况,从而有助于早期诊断和治疗。     

脊髓结核瘤的MR I表现分析并文献复习

目的：分析脊髓结核瘤的 MRI表现并文献复习。方法回顾性分析5例经临床和影像证实的脊髓结核瘤患者 MRI表现,所有患者MRI检查包括T1 WI、T2 WI平扫和T1 WI增强扫描,观察病变的部位、信号特点、强化方式和形态。结果1例病变位于颈段脊髓,为稍长T1、短T2信号,呈结节样强化;3例病变位于下胸段脊髓,横断位T2 WI表现为典型的“靶征”,增强后呈环状强化,矢状位其长轴与脊髓长轴一致,其中1例增强后发现合并1个平扫不能显示的粟粒强化结节;1例病变位于脊髓圆锥,为长 T1、短T2信号,增强后呈环状强化。结论脊髓结核瘤 MRI表现具有多样性,其特征性表现包括 T2 WI 低信号或“靶征”、环状强化、病变长轴与脊髓长轴一致。     

0.6 T MR imaging of the cervical spine: multislice and multiecho techniques

During a 6 month period, 50 patients with signs and symptoms referable to the cervical spine were studied with a 0.6 T superconducting magnetic resonance (MR) imaging unit. The last 23 of these 50 patients were studied with combined multislice and multiecho techniques. In 38 of the 50 patients, abnormalities were demonstrated on MR images. Intramedullary lesions included syringomyelia (three cases), primary tumors (two), metastatic neoplasm (one), cord atrophy secondary to trauma (one), and multiple sclerosis (one). Intradural, extramedullary lesions included two neurofibromas and two Chiari malformations. The rest of the lesions were extradural: degenerative changes (10), spinal stenosis with cord compression (five), disk degeneration and/or herniation (five), postoperative changes (four), metastases to bone/epidural disease (three), and neurofibromatosis (one). Two patients had more than one abnormality. The MR findings were compared with available routine radiographs, computed tomographic (CT) scans with and without metrizamide, and myelograms. MR imaging was consistently better than routine CT scanning in the detection of lesions of the spinal cord and in directly imaging the effects on the spinal cord of extrinsic abnormalities such as spinal stenosis. Metrizamide-enhanced CT scanning detected all cases of syringomyelia, but it involved an invasive procedure. Myelography alone was slightly less sensitive and considerably less specific than MR in detecting intramedullary lesions and in distinguishing cord neoplasms from syringomyelia. Multislice, multiecho techniques with up to 240 msec echo times (TEs) were particularly helpful in the detection and characterization of extradural processes.(ABSTRACT TRUNCATED AT 250 WORDS)     

无骨折脱位型颈髓损伤的MRI分析

目的 :探讨无骨折脱位型颈髓损伤的发生机理、好发部位及MRI特点。材料和方法 :回顾性分析 43例无骨折脱位型颈髓损伤的MRI表现。结果 :共发现脊髓异常MR信号 46处 ,多位于C4-6水平 ,异常信号T1WI为低信号、等信号或高信号 ;T2WI为信号均匀或不均匀的高信号。结论 :MRI能显示脊髓损伤的范围和病理改变 ,明确脊髓损伤处有无突出椎间盘的持续性压迫。是无骨折脱位型颈髓损伤最好的检查方法     

脊髓亚急性联合变性的MRI诊断要点分析

目的分析脊髓亚急性联合变性(SCD)的MRI诊断要点。资料与方法回顾性分析15例临床确诊SCD的病人临床及MRI资料,分析其脊髓MRI表现特点,统计分析SCD病人受累脊髓节段数与血清VB12水平、发病时间的相关性。结果 15例SCD病人均于横断面影像上显示颈胸段脊髓对称性等或长T1、长T2信号,13例病变主要位于颈胸段水平脊髓后索,2例同时累及后索、侧索及前索。但于横断面T2WI上颈段与胸段脊髓异常信号形态各具特点。颈段脊髓受累时于横断面T2WI上呈脊髓内"倒V"形或"反兔耳"形的对称性高信号。胸段脊髓受累时于横断面T2WI上呈脊髓内"哑铃"形的对称性高信号。统计学分析显示15例SCD病人脊髓受累节段数与血清VB12水平呈负相关,而与病程长短无相关性。结论脊髓MR成像对于SCD脊髓疾病的诊断有重要价值。     

椎管内血管性病变的MRI诊断

目的 总结不同类型椎管内血管性病变的影像特点,以提高对该类疾病的诊断水平. 资料与方法 对33例经手术病理或DSA证实的椎管内血管性病变的影像及临床资料进行回顾性分析,其中海绵状血管瘤11例(髓内8例,髓外硬脊膜外3例),血管母细胞瘤4例(单发2例,多发2例),动静脉病变18例(动静脉瘘12 例,动静脉畸形6例).所有病例均行MR平扫和增强扫描. 结果 椎管内血管性病变好发年龄在40岁左右,临床多表现为渐进性的神经系统受损症状.海绵状血管瘤髓内较髓外相对多见,髓内病变颈段好发,病变多局限,病灶周围T2低信号环较具特征性,强化多不明显;硬脊膜外海绵状血管瘤少见,多发生在胸段,常为边界清楚梭型肿物,均匀明显强化.血管母细胞瘤较少见,可单发亦可多发,多发生在颈、胸段,当伴有较大范围脊髓空洞或囊变,并有明显强化结节时,诊断不难;动静脉病变最多见, MRI多能发现蜿蜒血管流空信号,较易诊断,但具体分型有赖于DSA或手术. 结论 椎管内不同类型的血管性病变具有相对特异的影像表现,MRI可较好地显示病变,并能准确定位,同时可以显示脊髓变性的程度和范围,有利于病变的诊治及判断预后.     

放射性脊髓损伤的MRI诊断

目的：提高对放射性脊髓损伤ＭＲＩ表现的认识与诊断水平。方法：４例分别患鼻咽癌、纵隔淋巴瘤、食管癌及肺癌的患者,因放射治疗后５￣３６个月出现双下肢运动及感觉障碍而进行颈胸段脊髓ＭＲＩ检查。结果：脊髓病变在照射野内,表现为稍长或长Ｔ１、长Ｔ２信号。注射Ｇｄ－ＤＴＰＡ后,病变不同程度强化。结论：放射性脊髓损伤的ＭＲＩ表现具有一定的特征。     

中枢神经系统伸长细胞型室管膜瘤的MR I表现

目的：探讨中枢神经系统伸长细胞型室管膜瘤(TE)的 MRI表现,提高对其病理亚型的进一步认识。方法回顾性分析经手术病理证实的TE 26例,观察肿块发生的部位、大小、内部的信号特点、有无囊变、出血、“帽”征、脊髓空洞、水肿、有无种植转移及增强扫描后的强化特点等。结果26例中,幕上2例均位于左侧额叶,呈大囊小结节结构,与左侧脑室相通,囊内呈均匀脑脊液信号,结节均呈等T1稍短T2信号,增强扫描结节明显强化。椎管内24例,颈段及颈胸段肿瘤16例,1例为囊性肿块,可见出血液-液平面,余均为实性肿块,呈等T1、等或稍长T2信号,4例中心短T2出血信号,囊变常见,6例可见“帽”征,增强后12例边界清晰,大部分中等程度强化,13例有空洞形成,1例有延髓及小脑播散。胸腰段及腰段肿瘤8例,等T1、等或稍长T2信号,其中4例病灶中心有陈旧出血信号,3例病灶边缘小圆形囊变,1例病灶伴空洞,未见“帽”征,增强后呈中等强化。结论脑及脊髓内 TE 的MRI具有一定特征性表现,有助于术前诊断及指导临床治疗。     

A comparison between M.R.I. and C.T. in the investigation of neurological deterioration in longstanding spinal trauma.

MRI at 0.3T and CT with myelographic contrast (CTM) were compared in the retrospective evaluation of 35 patients investigated for the development of new neurological symptoms following longstanding spinal cord injury. Compared with MRI, CTM was relatively accurate for the demonstration of spinal cord compression, but failed to identify 23% of patients with spinal cord atrophy, and 43% of patients with post-traumatic syrinx formation. However, 5 patients had unsatisfactory MR imaging, either due to motion or metallic artifact, and in 3 of these, CTM demonstrated a syrinx. Although MRI is the method of choice in the investigation of this problem, CTM may still be required for patients with an unsatisfactory MR examination. Magnetic Resonance (MR) imaging is now an established technique for imaging the spine, with accurate depiction of the spinal cord, as well as the adjacent soft tissues (1, 2). However, the cost of this technique, and its as yet limited availability in Australasia, has resulted in the necessity to demonstrate its superiority over other imaging modalities for any specific clinical problem (3). One of the major areas of impact of MR has been in the investigation of the problem of acute neurological deterioration in patients with past spinal trauma (4, 5, 6). Some of these patients will have treatable causes of deterioration, either a post-traumatic syrinx, or spinal cord compression (6), and MR can be used to image these conditions (7), which, until recently, were investigated with computed tomography with myelographic contrast medium (CTM), (8, 9).(ABSTRACT TRUNCATED AT 250 WORDS)     

Diffusion-weighted MR imaging in a rat model of syringomyelia after excitotoxic spinal cord injury.

BACKGROUND AND PURPOSE: Recent experimental data have shown that an increase of excitatory amino acids and the initiation of inflammatory responses within the injured spinal cord may play a role in post-traumatic syringomyelia. The purpose of this study was to determine whether diffusion-weighted MR imaging with apparent diffusion coefficient (ADC) maps could provide earlier evidence of spinal cord cavitation in a rat model of syringomyelia than available with conventional MR imaging. METHODS: The spinal cord gray matter of four rats was injected with the alpha-amino-3 hydroxy-5 methyl-4 isoxazole propionic acid/metabotropic receptor agonist quisqualic acid. Animals were sacrificed at 1, 4, or 8 weeks after injection, and the spinal cords were fixed in formalin for 1 week and imaged with T1-, T2-, and diffusion-weighted sequences. One control specimen was also imaged. ADC maps were constructed from the diffusion-weighted data. Histopathologic analyses of sections stained with cresyl violet were compared with the MR images. RESULTS: By 1 week after injection, ADC maps at the level of injection showed areas within the gray matter of increased intensity and increased ADC values as compared with the control specimen. These bright areas corresponded to cysts or cavities within the cord parenchyma on the histopathologic sections. The ADC values within affected gray matter areas progressively increased at 4 and 8 weeks, also corresponding to cyst formation. Conventional T1- and T2-weighted images showed corresponding lesions with cystic characteristics at 4 and 8 weeks, but not at 1 week. CONCLUSION: In an animal model of syringomyelia, diffusion-weighted imaging with ADC maps detected cystic lesions within spinal cord gray matter before they were seen on conventional T1- and T2-weighted images.     

脊髓亚急性联合变性MRI影像分析

目的：探讨脊髓亚急性联合变性(SCD)的 MRI 影像特点。方法回顾分析19例 SCD 患者的临床特点及 MRI 资料。结果19例 SCD 中16例出现脊髓异常信号,主要位于颈胸段脊髓背侧,1例累及小脑皮层和延髓;病变为多节段脊髓受累,主要累及脊髓后索或侧索,其中2例累及前索;不同节段脊髓病灶可有不同的形态特征,增强扫描无强化;经维生素 B12治疗后病变范围有不同程度缩小,2例基本消失。结论MRI 对脊髓 SCD 的诊断及疗效监测具有重要价值。     

Tipps, Tricks und Fallstricke bei der Bildgebung von Myelonverletzungen

Over the last several decades the survival rate for acute spinal cord lesions has improved, which has resulted in an increased number of chronic spinal cord injuries. Magnetic resonance imaging (MRI) plays an essential role in imaging of the spinal cord, as it allows a detailed depiction of neural structures. However, the correct radiologic diagnosis is often complicated by the multitude of differential diagnoses. This article provides tips and tricks to achieve an accurate imaging report and details potential pitfalls in the interpretation of MR images. Acute spinal cord injuries show different characteristics which range from edema to intramedullary bleeding and to transsection. The spectrum of chronic spinal cord injuries encompasses myelomalacia, syrinx, cystic myelopathia and myeloatrophy. In addition to typical morphological features this article concentrates on the pathogenesis of injury patterns, on the use of appropriate contrast-enhanced MR sequences and on new MR techniques for the differentiation of individual pathologies.