椎管内硬脊膜外蛛网膜囊肿的低场强MRI诊断

目的:探讨椎管内硬脊膜外蛛网膜囊肿的低场强MRI表现特征,提高对该病的认识。方法:回顾性分析12例经手术病理证实的硬脊膜外蛛网膜囊肿的临床及MRI表现特征,其中10例行Gd DTPA增强扫描,7例行X光平片或CT片检查。结果:本组病例发病于胸腰段8例,位于脊髓背侧9例,呈典型的椎管内硬脊膜外占位病变征象,囊肿的信号强度与脑脊液一致或相近,上、下缘与硬脊膜外脂肪毗邻,上或下方邻近硬脊膜的显示,可为硬脊膜外囊肿的定位诊断提供有力的佐证,囊肿与蛛网膜下腔相交通时,孔道区囊肿内可出现流空信号,可确定孔道的具体位置,为手术提供可靠可靠的依据。结论:MRI是目前评价椎管内硬脊膜外蛛网膜囊肿的定位和定性诊断最佳影像学方法和首选检查手段。     

急性硬脊膜外血肿的MRI研究

目的 探讨急性硬脊膜外血肿(ASEH)的发病机制、MRI表现特征及鉴别诊断。方法 15例ASEH病人，男8例，女7例，平均37．8岁。5例有脊柱损伤史，1例有脊柱手术史，1例有腰硬脊膜穿刺史，其余8例无特殊病史。11例经手术证实，2例经CT引导穿刺抽吸治疗并证实，2例经临床相应检查及随访证实。所有病人均行矢状面SE T1WI和快速SE(FSE)或SE T2WI。12例行横轴面FSE T2WI，8例行SE T1WI。4例行SE T1WI增强扫描。结果 15例血肿共发生于18个脊柱节段，其中6例次(6／18)位于颈段、9例次(9／18)位于胸段、3例次(3／18)位于腰段。7例次(7／18)血肿位于硬膜囊前方，11例次(11／18)位于硬膜囊后方。血肿累及1～13个椎体高度，平均4．87个椎体高度。T1WI上，所有血肿与脊髓之间均显示有线样低信号区。T2WI矢状面和横轴面上，分别有4例(4／15)和8例(8／12)在血肿与蛛网膜下腔之间显示有低信号线。矢状面上13例(13／15)血肿呈长梭形，横轴面上均呈双凸镜形或半圆形。SE T1WI上，5例呈等T1信号，6例呈短T1信号，4例呈等、短T1混杂信号；T2WI上，5例呈短T2信号，10例呈短、长T2混杂信号。4例增强扫描无特异性。结论 ASEH的MRI表现具有特征性，可为诊断及鉴别诊断提供依据。     

浅析脊髓前动脉综合征MRI诊断

目的：探讨脊髓前动脉综合征的病因、发病机制和MRI表现特点。方法：回顾性分析11例脊髓前动脉综合征患者的临床资料和MRI表现。结果：11例在MRI矢状面图像上均表现为范围不一的脊髓腹侧T2WI高信号灶,FLAIR图像上呈高信号,边界较清楚,其中T1WI上7例呈低信号,4例无信号改变;横轴面图像上3例可见典型的脊髓前角圆形病灶,呈＂鹰眼征＂。病灶位于颈段1例（1/11）,胸段4例（4/11）,颈胸结合段3例（3/11）,胸腰结合段3例（3/11）。2例同时显示颈椎病和椎管狭窄,2例显示主动脉夹层,1例合并椎管内血管畸形。结论：脊髓前动脉综合征的MRI表现具有一定特征性,MRI对明确诊断以及病因判断有重要的临床应用价值。     

脊髓血管畸形的临床特征与影像学分类的相关性研究

目的：分析研究脊髓血管畸形的临床特征与影像学分类的相关关系。材料和方法：收集了６２例经ＭＲＩ、ＤＳＡ和（或）手术病理证实的髓血管畸形患者,其中髓内隐匿型动静脉畸形（ＡＶＭｓ）１３例、球形ＡＶＭｓ５例、幼稚型ＡＶＭｓ１２例：髓周膜内动静脉瘘（ＡＶＦ）Ⅰ型５例、Ⅱ型１２例、Ⅲ型７例;硬膜型ＡＶＦ８例。结果：脊髓ＡＶＭｓ中,隐匿型ＡＶＭｓ无明显的性别差异,余各类型男性均多于女性;髓内ＡＶＭｓ、髓周ＡＶＦ以青少年多见,硬膜型ＡＶＦ发生于中老年;髓内ＡＶＭｓ多见于颈髓及胸腰段脊髓,髓周ＡＶＦ及硬膜型ＡＶＦ多见于胸腰段;髓内ＡＶＭｓ以急性起病多见,髓周ＡＶＦ表现为进行性加重,少数可急性发作,硬膜型ＡＶＦ以慢性起病多见;髓内出血者预后较无出血者差。结论：根据临床症状、起病特征可初步判断病变类型,争取早期正确诊断、早期治疗,为     

Spinal osteoblastoma: CT and MR imaging with pathological correlation

Objectives. To illustrate the CT and MRI features of spinal osteoblastomas and correlate the imaging with histological findings. Design. In a retrospective review the CT and MRI features of spinal osteoblastomas with respect to mineralisation, signal intensity (SI), adjacent reactive changes, enhancement following gadolinium-DTPA (5 cases) and adjacent soft tissue masses were compared and correlated with the histological findings including the degree of osteoid formation and matrix mineralisation, vascularity and surrounding reactive changes in bone and soft tissue. Patients. Eleven patients (7 males and 4 females; age range 8–43 years, mean age 19.5 years) with 12 osteoblastomas (1 patient suffered a recurrence) were studied. Results. All lesions showed classical features on CT with varying degrees of matrix mineralisation, whereas MRI identified mineralisation in only eight of 12 cases. MRI showed low signal intensity of the lesion on both T1- and T2-weighted sequences in several cases in the absence of heavy mineralisation. In these cases, histological examination revealed diffuse osteoid production by the tumour. All patients given gadolinium showed enhancement within the tumour on MRI. Reactive bone marrow changes were identified on MRI in 10 cases, and in five of these the changes were at multiple levels. An adjacent soft tissue mass was demonstrated in five cases, but extraosseous tumour was present histologically in only two of these. Conclusions. The MRI appearances of spinal osteoblastomas are varied and show no characteristic features. MRI may also overestimate the extent of the lesion due to extensive reactive changes and adjacent soft tissue masses. CT should continue to be the investigation of choice for the characterisation and local staging of suspected spinal osteoblastomas.     

脊椎结核的MRI诊断价值与脊椎转移瘤对照研究

目的探讨MRI对脊椎结核的诊断价值。材料与方法对13例脊椎结核行矢状位T1WI、T2WI、DWI、FAST准T2WI及轴位T1WI成像;7例行Gd-DTPA增强。随机抽取30例脊椎转移瘤作对照组。观察两组病变椎体、终板、椎间盘和周围软组织的信号变化和增强后改变。结果(1)MRI对鉴别椎体骨炎和转移瘤性椎体骨浸润价值较大;(2)骨内与椎旁冷脓肿形成及椎间盘改变是脊柱结核的典型删表现;(3)Gd-DTPA增强可清楚显示冷脓肿周围纤维肉芽组织及椎管内侵犯;(4)终板破坏常见于脊椎结核。结论MRI对脊椎结核与脊椎转移瘤有较大鉴别诊断价值,对早期和不典型脊椎结核的诊断亦有较大价值。     

硬脊膜动静脉瘘的MRI和DSA影像学特点及栓塞治疗

目的 探讨硬脊膜动静脉瘘的MRI和DSA影像学特点及血管内栓塞治疗方法。方法 12例硬脊膜动静脉瘘患者均行MRI和脊髓血管造影检查,4例行栓塞治疗。分析其MRI和血管造影表现。结果 12例硬脊膜动静脉瘘中,MRI屉示脊髓内弥漫性长T2信号影11例,脊髓斑片状强化2例,脊髓背侧异常血管影6例。脊髓血管造影均能显示其瘘口和引流静脉,并反映其病变范围、供血状况及特征。4例行栓塞治疗患者其临床症状均有改善。结论 脊髓血管造影是诊断硬脊膜动静脉瘘的主要确诊方法。MRI对确定诊断具有重要作用。血管内栓塞是一种有效的治疗方法。     

椎管内蛛网膜囊肿MRI表现及诊断价值

目的 分析椎管内蛛网膜囊肿MRI特点及其诊断价值。资料与方法 搜集经手术病理证实的椎管内蛛网膜囊肿59例，其中男24例，女35例，行横断、冠状及矢状面MR SE序列扫描，8例加做Gd—DTPA增强扫描。结果 椎管内硬膜外蛛网膜囊肿4例，骶管内蛛网膜囊肿42例，神经鞘膜囊肿10例，椎管内硬膜下蛛网膜囊肿3例。囊肿T1WI呈低信号，T2WI呈高信号，囊液信号与脑脊液信号一致。59例定位、定性诊断全部正确。结论 椎管内蛛网膜囊肿的MRI表现较具特征性，MRI可对其作出正确诊断，并指导手术。     

继发椎管狭窄与脊髓亚急性联合变性MRI异常信号的相关性

目的：研究脊髓亚急性联合变性(SCD)的 MRI 表现特点,探讨继发椎管相对狭窄与 SCD 的 MR 异常信号的相关性。方法收集56例 SCD 患者的临床及 MRI 影像资料,分析 SCD 病例中椎间盘膨出/突出、黄韧带增厚、后纵韧带增厚或两者以上协同作用下的椎管相对狭窄与脊髓内病灶的表现特点。结果56例 SCD 患者中,MRI 检查脊髓表现有病灶的45例,均表现为典型的SCD 影像表现。继发椎管相对狭窄并脊髓信号异常者37例,继发椎管相对狭窄脊髓未见异常信号者2例,无继发椎管相对狭窄脊髓信号异常者8例,无继发椎管相对狭窄脊髓也未见异常信号者9例。比较采用χ2检验统计继发椎管相对狭窄与脊髓异常信号有显著性差异(P <0.05)。37例 SCD 有继发椎管相对狭窄中15例行物理治疗后较对照组病程缩短。结论继发椎管相对狭窄致脊髓微循环障碍是导致 SCD 脊髓病变 MRI 表现更显著或更易于显现的重要因素。     

Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration

The objective of this study was to demonstrate lumbosacral interspinous ligament rupture, with or without related acute intrinsic spinal muscle degeneration.This study consisted of a prospective imaging analysis of consecutive 100 MRI studies in adult patients (mean age 56 years) presenting with low back pain. Alterations from the normal in the inter- and perispinal structures of the spine and perispinal soft tissues (e.g., spinal ligaments, perispinal muscles) were sought based upon studies on young volunteers without low back pain ( n=10; mean age 23 years). Compared with the group without low back pain, many index cases ( n=71, 71%) demonstrated hyperintensity (i.e., sprain or frank ligamentous rupture) of the interspinous ligament(s) on T2-weighted, fat-suppressed MRI studies at one (20 of 71, 28%) or multiple (51 of 71, 72%) levels. Associated intrinsic spinal muscle (e.g., interspinalis, multifidus muscles) degeneration was observed in a minority of cases overall ( n=7, 7%), but was only seen in association with cases also demonstrating interspinous ligament degeneration/rupture (7 of 71, 10%). Lumbosacral interspinous ligament sprain or frank rupture, as well as related acute-subacute autotraumatic intrinsic spinal muscle rupture/degeneration, may be overlooked by many observers if fat-suppressed, T2-weighted MRI is not acquired. These musculoligamentous alterations are on occasion the only abnormalities recognized on MRI of the lumbosacral spine and may theoretically be sources of low back morbidity that potentially may respond to specific therapy. Because this study was an observational one, based solely upon medical imaging, future research must focus upon the correlation of the relevance of these findings with an age-matched asymptomatic control group and longitudinal clinicoradiologic therapeutic trials.     

Conventional and CT metrizamide myelography in Arnold-Chiari I malformation and syringomyelia

Four normal controls and 26 cases of Arnold-Chiari I malformations and/or syringomyelia were reviewed. The pathologic cases included five isolated Arnold-Chiari I malformations, nine communicating syringomyelia, five idiopathic syringomyelia, four posttraumatic syringomyelia, one syringomyelia with hemangioblastoma, and two postshunt syringomyelia. The objectives of this study were to compare the accuracy of conventional metrizamide myelography with CT metrizamide myelography and to study indirectly the hydrodynamics of CSF flow in syringomyelia by comparing the sequential enhancement patterns of the spinal cords and cord cavities in the different groups of patients. Twenty-five patients underwent conventional metrizamide myelography immediately before CT metrizamide myelography, and one patient underwent CT metrizamide myelography only. Scans were obtained 1-2 hr, 4-8 hr, and 12-24 hr after injection of metrizamide, but not all patients were scanned during all three intervals. CT metrizamide myelography was found to be more sensitive than conventional metrizamide myelography in the diagnosis of both Arnold-Chiari I malformation and syringomyelia. Performing just an immediate and a delayed scan was found to be more cost-effective than doing all three scans. Contrary to previous reports, it was found that delayed (12-24 hr) scans demonstrated more syrinx cavities than intermediate ones. In studying the sequential enhancement patterns of the spinal cords and cord cavities, some interesting trends were observed that tend to support the theories of Aboulker and of Ball and Dayan of transneural passage of CSF into cord cavities in syringomyelia.     

椎管内脊髓外海绵状血管瘤的MRI诊断

目的:探讨椎管内脊髓外海绵状血管瘤的MRI表现,提高对本病的认识。方法:回顾性分析本院经病理证实的8例椎管内脊髓外海绵状血管瘤的MRl资料,并与临床及病理学资料作对照分析。结果:8例海绵状血管瘤中的7例位于硬膜外,1例位于髓外硬膜下;2例位于颈胸段,2例位于胸段,2例位于胸腰段,2例位于腰骶段。肿块多呈不规则形,2例包绕硬脊膜生长,4例突入相邻的椎间孔生长,病灶典型的MRI表现为T1WI呈等信号、T2WI呈高信号、T1WI增强扫描呈均匀强化。病理显示肿块为异常薄壁血管丛,腔呈圆形或不规则形,内含大量红细胞。结论:椎管内髓外海绵状血管瘤的MRI征象具有一定特点,MRI有助于椎管内髓外海绵状血管瘤的诊断与术前定位。     

急性脊髓炎的磁共振诊断

目的探讨急性脊髓炎的MR I特征。方法对25例急性脊髓炎的临床及MR I影像资料加以分析。结果急性脊髓炎MR I表现特点为:病变区脊髓呈均匀一致性的肿胀增粗,外缘光整,一般多呈轻度增粗(19/25),少数增粗显著(1/25),也可以不增粗,脊髓无外形的改变(5/25);T2加权像病变区脊髓信号增高;病变范围较长,多为4个椎体高度或以上(20/25),上界常高于临床感觉平面;增强MR I检查不显示强化(8/18)或仅有轻度斑片状强化(10/18)。亦对MR I检查的诊断价值和有关的鉴别诊断进行了讨论。结论MR I对急性脊髓炎的诊断价值较大。     

MRI与CT对颅颈移行区肿瘤的诊断价值评估：附16例分析

本文旨在评价ＭＲＩ与ＣＴ对颅颈移行区病变的诊断价值，共１６例分析，包括斜坡脊索瘤５例，小脑下蚓部肿瘤２１例，延髓肿瘤４例，上颈段脊髓肿瘤５例。患者均作ＭＲＩ平扫，采用ＳＥ系列，Ｔ１Ｗ（ＴＲ５００／ＴＥ３０ｍｓ）、Ｔ２Ｗ（ＴＲ１８００／ＴＥ９０ｍｓ）和质子密度像（ＴＲ１８００／ＴＥ３０ｍｓ），其中２例作了Ｇｄ－ＤＴＰＡ顺磁增强，所有病例均作了ＣＴ平扫，６例同时还作了增强ＣＴ扫描。通过本组病例分析：１     

椎管内表皮样囊肿的MRI表现

目的:探讨椎管内表皮样囊肿的MR表现。方法:回顾性分析16例经手术病理证实的椎管内表皮样囊肿的 MRI表现。常规行SE T1WI、TSE T2WI和STIR扫描,14例行Gd-DTPA增强扫描。结果:16例中12例病灶位于髓外硬膜下,4例位于脊髓内,合并其它先天畸形6例。MR表现为T1WI上呈低信号8例,等、低混杂信号6例,等、低、高混杂信号2例;T2WI上呈高信号10例,等、高混杂信号5例、等、低混杂信号1例;3例肿瘤内有脂肪信号。11例患者行增强扫描,肿瘤内部均无强化,肿瘤边缘轻度强化2例。结论:椎管内表皮样囊肿的MRI表现有一定特征性,除与皮样囊肿鉴别困难外,与其它椎管内肿瘤容易鉴别。     

原发性脑内淋巴瘤的MRI诊断

目的 总结原发性脑内淋巴瘤的MRI特点,以提高诊断的正确性. 资料与方法 回顾分析19例经手术病理证实的原发性脑内淋巴瘤的MRI资料. 结果 单发18例,多发1例;幕上16例,幕下3例.幕上14例位于大脑半球深部近或中线区,2例以宽基底靠近脑表面,幕下2例位于小脑半球,1例位于第四脑室.T1WI呈等信号13例,稍低信号6例,T2WI呈稍高信号3例,等信号10例,稍低信号6例.增强后9例呈明显均匀强化的团块状,5例呈内伴小囊变区的团块状,2例呈散在絮状强化,1例呈花环状强化,1例呈不均匀团状强化.1例位于胼胝体的病灶呈胼胝体的均匀强化.2例病变可见邻近室管膜的强化,1例可见"脑膜尾征".瘤周水肿轻度6例,中度10例,重度3例. 结论 原发性脑内淋巴瘤大多具有较典型的MRI特征,少数表现亦可多样,只要结合临床资料认真分析病变,误诊是可以明显减少的.     

自发性眶内出血的影像表现

目的 分析自发性眶内出血的影像表现,探讨不同影像技术对其诊断的价值.方法 回顾性分析30例经手术病理或穿刺证实的自发性眶内出血的超声、CT和MRI表现,并与病理或临床结果进行对照分析.结果 30例中18例经手术证实,其中单纯性血囊肿6例,静脉性血管瘤伴血囊肿形成10例(畸形血管位于肌肉圆锥内7例,眼外肌3例),静脉曲张伴血囊肿形成2例(畸形血管位于肌肉圆锥内、眼外肌各1例),另12例由穿刺证实.30例自发性眶内出血在超声上均表现为回声不均匀的囊性结构伴轻度可压缩性,且内部无血流.所有病例在CT平扫上均表现为等或稍高密度影,缺乏特征性,但病灶的CT值随着时间的推移具有下降趋势,其中发病1～3 d者4例,CT值为82.0～89.0 HU,发病4～20 d者20例,CT值为69.0～82.0 HU;发病21 d至2个月者6例,CT值为30.0～37.0 HU.在MRI上,病灶具有典型的血肿信号特征及演变规律,发病1～3 d(4例),T1WI呈等信号,T2WI呈明显的低信号;发病4～10 d(10例),T1WI上病灶内部出现高信号区,T2WI上仍呈低信号;发病11～20 d(10例),T1WI呈均匀或不均匀高信号,T2WI上呈均匀高信号;发病21 d至2个月(6例),T1WI和T2WI上均呈高、低混杂信号表现.超声、CT平扫和MRI对自发性眶内出血诊断的临床符合率分别为96.7%(29/30)、26.7%(8/30)和100%(30/30),但均难以区分单纯性和继发性眶内血肿.结论 MRI对自发性眶内出血的诊断以及对血肿引起的继发性改变的评价作用均优于超声和CT.     

自发性眶内出血的影像表现

目的 分析自发性眶内出血的影像表现,探讨不同影像技术对其诊断的价值.方法 回顾性分析30例经手术病理或穿刺证实的自发性眶内出血的超声、CT和MRI表现,并与病理或临床结果进行对照分析.结果 30例中18例经手术证实,其中单纯性血囊肿6例,静脉性血管瘤伴血囊肿形成10例(畸形血管位于肌肉圆锥内7例,眼外肌3例),静脉曲张伴血囊肿形成2例(畸形血管位于肌肉圆锥内、眼外肌各1例),另12例由穿刺证实.30例自发性眶内出血在超声上均表现为回声不均匀的囊性结构伴轻度可压缩性,且内部无血流.所有病例在CT平扫上均表现为等或稍高密度影,缺乏特征性,但病灶的CT值随着时间的推移具有下降趋势,其中发病1～3 d者4例,CT值为82.0～89.0 HU,发病4～20 d者20例,CT值为69.0～82.0 HU;发病21 d至2个月者6例,CT值为30.0～37.0 HU.在MRI上,病灶具有典型的血肿信号特征及演变规律,发病1～3 d(4例),T1WI呈等信号,T2WI呈明显的低信号;发病4～10 d(10例),T1WI上病灶内部出现高信号区,T2WI上仍呈低信号;发病11～20 d(10例),T1WI呈均匀或不均匀高信号,T2WI上呈均匀高信号;发病21 d至2个月(6例),T1WI和T2WI上均呈高、低混杂信号表现.超声、CT平扫和MRI对自发性眶内出血诊断的临床符合率分别为96.7%(29/30)、26.7%(8/30)和100%(30/30),但均难以区分单纯性和继发性眶内血肿.结论 MRI对自发性眶内出血的诊断以及对血肿引起的继发性改变的评价作用均优于超声和CT.     

自发性眶内出血的影像表现

目的 分析自发性眶内出血的影像表现,探讨不同影像技术对其诊断的价值.方法 回顾性分析30例经手术病理或穿刺证实的自发性眶内出血的超声、CT和MRI表现,并与病理或临床结果进行对照分析.结果 30例中18例经手术证实,其中单纯性血囊肿6例,静脉性血管瘤伴血囊肿形成10例(畸形血管位于肌肉圆锥内7例,眼外肌3例),静脉曲张伴血囊肿形成2例(畸形血管位于肌肉圆锥内、眼外肌各1例),另12例由穿刺证实.30例自发性眶内出血在超声上均表现为回声不均匀的囊性结构伴轻度可压缩性,且内部无血流.所有病例在CT平扫上均表现为等或稍高密度影,缺乏特征性,但病灶的CT值随着时间的推移具有下降趋势,其中发病1～3 d者4例,CT值为82.0～89.0 HU,发病4～20 d者20例,CT值为69.0～82.0 HU;发病21 d至2个月者6例,CT值为30.0～37.0 HU.在MRI上,病灶具有典型的血肿信号特征及演变规律,发病1～3 d(4例),T1WI呈等信号,T2WI呈明显的低信号;发病4～10 d(10例),T1WI上病灶内部出现高信号区,T2WI上仍呈低信号;发病11～20 d(10例),T1WI呈均匀或不均匀高信号,T2WI上呈均匀高信号;发病21 d至2个月(6例),T1WI和T2WI上均呈高、低混杂信号表现.超声、CT平扫和MRI对自发性眶内出血诊断的临床符合率分别为96.7%(29/30)、26.7%(8/30)和100%(30/30),但均难以区分单纯性和继发性眶内血肿.结论 MRI对自发性眶内出血的诊断以及对血肿引起的继发性改变的评价作用均优于超声和CT.     

MR imaging of syringomyelia and hydromyelia

The relative effectiveness of plain computed tomography (CT), metrizamide CT, conventional myelography, and magnetic resonance (MR) imaging was compared for the examination of cystic spinal cord lesions. Intramedullary cavities in 18 patients were demonstrated by MR imaging: cavities were uncomplicated in 13 patients, associated with spinal tumors in two, and studied after occipital craniectomy for treatment of Chiari malformation and syringomyelia in two. Cavities were shown by MR imaging in all enlarged spinal cords, but a cavity was shown in only one of four small cords. The rostral limits of the cavities were demonstrated better than were the caudal extensions. Ventricular communication was not demonstrated. Chiari malformation was shown only in cavities that did not involve the medulla. Syringes associated with tumor were indistinguishable from uncomplicated cavities, but the tumor had abnormal signal on long spin-echo sequences in two cases. Cystic cord tumor (one case) had an inhomogeneous appearance. Caudal displacement of the cerebellar hemisphere through the surgical defect associated with compression of the fourth ventricle was shown in two cases after posterior fossa craniectomy. Thirteen patients were studied with metrizamide CT also. MR imaging proved to be as accurate as metrizamide CT in the diagnosis of intramedullary cavities that result in spinal cord enlargement, but it was less sensitive in detecting cavities within normal-sized or diminished spinal cords. It had the advantage that tumor tissue could be distinguished from associated syrinx cavities by differences in signal characteristics; and cerebellar ectopia was evaluated easily on sagittal MR views.