成人无骨折脱位型颈脊髓损伤的手术治疗

目的探讨成人无骨折脱位型颈脊髓损伤（CSCIWOFD）的手术策略及治疗效果。方法回顾性分析我院28例手术治疗的成人CSCIWOFD患者的临床资料。颈椎X线或CT检查示发育性颈椎管狭窄2例,退变性颈椎管狭窄8例,颈椎后纵韧带骨化2例,第2、3颈椎阻滞椎1例,颈椎退行性改变15例。颈椎MRI示脊髓水肿15例,脊髓出血或血肿7例,脊髓软化或空洞6例;颈椎间盘损伤突出26例,其中单节段9例,两节段12例,多节段5例;前纵韧带损伤4例。前路减压椎间融合固定术18例,后路颈椎管扩大成形术9例,前路减压椎间融合固定术联合后路颈椎管扩大成形术1例。按美国脊髓损伤协会（ASIA）分级标准评价患者入院时和末次随访时脊髓神经功能。结果 28例随访时间6～87个月,平均34.4个月。患者脊髓功能ASIA分级：入院时A级2例,B级4例,C级6例,D级16例,E级0例;末次随访时A级2例,B级0例,C级2例,D级20例,E级4例,其神经系统症状较入院时有不同程度改善（P〈0.05）。结论对于成人CSCIWOFAD,根据其病情特点选择适宜的手术方式,可以获得较好的临床疗效。     

Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury

BACKGROUND AND PURPOSE: The incidence of blunt traumatic vertebral artery dissection/thrombosis varies widely in published trauma series and is associated with spinal trauma. The purpose of this study was to determine the frequency of traumatic vertebral artery thrombosis (VAT) in cervically injured patients by using routine MR angiography (MRA) and MR imaging and identify associations with the severity of neurologic injury. METHODS: A retrospective review of 1283 patients with nonpenetrating cervical spine fractures with or without an associated spinal cord injury (SCI) was performed. Imaging consisted of routine cervical MR imaging and 2D time-of-flight MRA of the neck. The cervical injury level, neurologic level of injury, and American Spinal Injury Association (ASIA) grade were recorded. RESULTS: In this study, 632 patients met the inclusion criteria, 83 (13%) of whom had VAT on the admission MR imaging/MRA. Fifty-nine percent (49/83) of VAT patients had an associated SCI. VAT was significantly more common in motor-complete patients (ASIA A and B, 20%) than in neurologically intact (ASIA E, 11%) cervical spine-injured patients (P = .019). VAT incidence was not significantly different between motor-incomplete (ASIA C and D, 10%) and neurologically intact (ASIA E, 11%) cervical spine-injured patients (P = .840). CONCLUSION: The absence of neurologic symptoms in a patient with cervical spine fracture does not preclude VAT. VAT associated with cervical spinal injury occurs with similar frequency in both neurologically intact (ASIA E) and motor-incomplete patients (ASIA C and D) but is significantly more common in motor-complete SCI (ASIA A and B).     

Intraoperative sonography of cervical spinal cord injury: results in 30 patients

Intraoperative spinal sonography (IOSS) with a 7.5-MHz sector transducer was performed in 30 patients with cervical spine injury associated with neurologic deficits. A laminectomy (25 patients) or anterior corpectomy (five patients) during spinal surgery provided the IOSS imaging window. The surgery was performed for either spinal decompression or fixation as part of the initial care of these patients and occurred 1 to 39 days (mean, 12.4 days) after injury. Parenchymal spinal cord lesions at the level of cervical fracture or stenosis that were compatible with the initial neurologic deficits were detected by IOSS in 28 (96.5%) of 29 patients with technically adequate studies. Lesions appeared as foci of increased echogenicity and were sorted into five injury grades (0 through IV). The IOSS injury grade in each patient was determined by the maximal diameter of regions of increased echogenicity and/or cyst formation in either the sagittal or transverse image plane. The extent of initial neurologic injury and its recovery was assessed by using the ASIA motor score (0 to 100 unit scale) at admission and during follow-up. The IOSS injury grade was correlated with the initial ASIA motor score (p less than 0.009, Spearman's Rank Order Test), indicating that the IOSS echogenicity is related to the extent of initial clinical motor deficit. Regression analysis disclosed that both the IOSS injury grade and the initial ASIA score were correlated with the follow-up ASIA score (p less than 0.05 and p less than 0.001, respectively). However, the the addition of IOSS injury grade to the initial ASIA motor score did not improve the predictive ability of the follow-up ASIA motor score. This was interpreted as indicating that the IOSS injury grade and initial ASIA motor score contain similar information about the extent of the traumatic spinal cord injury. IOSS was compared with concurrently performed cervical spine MR images in 12 patients. IOSS confirmed parenchymal lesions demonstrated by MR (five patients), revealed cord lesions not detected by suboptimal MR studies (three patients), and better characterized lesions with early cyst formation (two patients). IOSS did not detect possibly significant herniated intervertebral disks in two patients because of its limited field of view.     

Intraoperative sonography of cervical spinal cord injury: results in 30 patients

Intraoperative spinal sonography (IOSS) with a 7.5-MHz sector transducer was performed in 30 patients with cervical spine injury associated with neurologic deficits. A laminectomy (25 patients) or anterior corpectomy (five patients) during spinal surgery provided the IOSS imaging window. The surgery was performed for either spinal decompression or fixation as part of the initial care of these patients and occurred 1 to 39 days (mean, 12.4 days) after injury. Parenchymal spinal cord lesions at the level of cervical fracture or stenosis that were compatible with the initial neurologic deficits were detected by IOSS in 28 (96.5%) of 29 patients with technically adequate studies. Lesions appeared as foci of increased echogenicity and were sorted into five injury grades (0 through IV). The IOSS injury grade in each patient was determined by the maximal diameter of regions of increased echogenicity and/or cyst formation in either the sagittal or transverse image plane. The extent of initial neurologic injury and its recovery was assessed by using the ASIA motor score (0 to 100 unit scale) at admission and during follow-up. The IOSS injury grade was correlated with the initial ASIA motor score (p less than 0.009, Spearman's Rank Order Test), indicating that the IOSS echogenicity is related to the extent of initial clinical motor deficit. Regression analysis disclosed that both the IOSS injury grade and the initial ASIA score were correlated with the follow-up ASIA score (p less than 0.05 and p less than 0.001, respectively). However, the addition of the IOSS injury grade to the initial ASIA motor score did not improve the predictive ability of the follow-up ASIA motor score.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rheumatoid arthritis: epidural enhancement as an underestimated cause of subaxial cervical spinal stenosis

PURPOSE: To assess the frequency and site of subaxial spinal canal stenosis due to enhancing tissue in patients with rheumatoid arthritis. MATERIALS AND METHODS: Data from 33 consecutive patients with rheumatoid arthritis were evaluated; these patients had undergone 1.5-T magnetic resonance imaging following gadolinium chelate administration, in combination with a frequency selective fat-suppression technique. Stenosis and enhancement were scored for each of six cervical spinal levels and were compared with results in a control population consisting of 16 patients with degenerative disease. Enhancement was scored as superficial or deep on the anterior and posterior sides from the cervical spinal cord. Differences between patient groups were tested by using the chi(2) test for trend and the Fisher exact test. RESULTS: No significant difference was found in the frequency or severity of subaxial stenosis between rheumatoid arthritis and degenerative disease. Deep epidural enhancement was observed more often with rheumatoid arthritis than with degenerative disease both anterior (25 of 33 patients vs seven of 16 patients, respectively; P <.001) and posterior (24 of 33 patients vs two of 16 patients, respectively; P =.001) to the spinal cord. Enhancing stenosing tissue in rheumatoid arthritis frequently occurred anterior and posterior at the same time and at the same level, with segmental cufflike extension of enhancing tissue around the dural sac. Stenosing tissue enhanced more frequently with rheumatoid arthritis than with degenerative disease (22 of 33 vs four of 16 patients, respectively; P =.008). CONCLUSION: In patients with rheumatoid arthritis, subaxial stenosis is frequently caused by enhancing epidural tissue. This enhancing tissue presumably represents pannus.     

CT colonography: influence of 3D viewing and polyp candidate features on interpretation with computer-aided detection

PURPOSE: To retrospectively determine if three-dimensional (3D) viewing improves radiologists' accuracy in classifying true-positive (TP) and false-positive (FP) polyp candidates identified with computer-aided detection (CAD) and to determine candidate polyp features that are associated with classification accuracy, with known polyps serving as the reference standard. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained; this study was HIPAA compliant. Forty-seven computed tomographic (CT) colonography data sets were obtained in 26 men and 10 women (age range, 42-76 years). Four radiologists classified 705 polyp candidates (53 TP candidates, 652 FP candidates) identified with CAD; initially, only two-dimensional images were used, but these were later supplemented with 3D rendering. Another radiologist unblinded to colonoscopy findings characterized the features of each candidate, assessed colon distention and preparation, and defined the true nature of FP candidates. Receiver operating characteristic curves were used to compare readers' performance, and repeated-measures analysis of variance was used to test features that affect interpretation. RESULTS: Use of 3D viewing improved classification accuracy for three readers and increased the area under the receiver operating characteristic curve to 0.96-0.97 (P<.001). For TP candidates, maximum polyp width (P=.038), polyp height (P=.019), and preparation (P=.004) significantly affected accuracy. For FP candidates, colonic segment (P=.007), attenuation (P<.001), surface smoothness (P<.001), distention (P=.034), preparation (P<.001), and true nature of candidate lesions (P<.001) significantly affected accuracy. CONCLUSION: Use of 3D viewing increases reader accuracy in the classification of polyp candidates identified with CAD. Polyp size and examination quality are significantly associated with accuracy.     

The early evolution of spinal cord lesions on MR imaging following traumatic spinal cord injury

BACKGROUND AND PURPOSE: How early spinal cord injury (SCI) lesions evolve in patients after injury is unknown. The purpose of this study was to characterize the early evolution of spinal cord edema and hemorrhage on MR imaging after acute traumatic SCI.MATERIALS AND METHODS: We performed a retrospective analysis of 48 patients with clinically complete cervical spine injury. Inclusion criteria were the clear documentation of the time of injury and MR imaging before surgical intervention within 72 hours of injury. The length of intramedullary spinal cord edema and hemorrhage was assessed. The correlation between time to imaging and lesion size was determined by multiple regression analysis. Short-interval follow-up MR imaging was also available for a few patients (n = 5), which allowed the direct visualization of changes in spinal cord edema.RESULTS: MR imaging demonstrated cord edema in 100% of patients and cord hemorrhage in 67% of patients. The mean longitudinal length of cord edema was 10.3 ± 4.0 U, and the mean length of cord hemorrhage was 2.6 ± 2.0 U. Increased time to MR imaging correlated to increased spinal cord edema length (P = .002), even after accounting for the influence of other variables. A difference in time to MR imaging of 1.2 days corresponded to an average increase in cord edema by 1 full vertebral level. Hemorrhage length was not affected by time to imaging (P = .825). A temporal increase in the length of spinal cord edema was confirmed in patients with short-interval follow-up MR imaging (P = .003).CONCLUSION: Spinal cord edema increases significantly during the early time period after injury, whereas intramedullary hemorrhage is comparatively static.

Acute traumatic spinal cord injury (SCI) is a devastating event with an incidence of approximately 11,000 injuries in the United States each year.¹ MR imaging is critical to the assessment of acute cervical SCI because it clearly depicts lesion location, extent, and severity. Spinal cord intramedullary edema and hemorrhage are readily appreciated^2,3 and, to some extent, correlate with the clinical neurologic deficit.^4–10 Prior studies have also revealed that both the presence of hemorrhage and increased hematoma length at MR imaging are associated with decreased motor recovery.^7–10Following the immediate structural and neurovascular insult, acute SCI sets into motion a cascade of secondary injuries.^11,12 Work in animals has shown that intramedullary spinal cord hemorrhage and edema are dynamic, whether assessed by histopathology or MR imaging.^13,14The extent to which cord lesions evolve in patients during the early phase of SCI (ie, the first hours and days postinjury) is unknown; therefore, given similar clinical deficits, it is unclear to what extent variability in lesion size reflects differences in time to imaging after trauma. Similarly, it is not clear whether lesion expansion when observed on a short-interval follow-up MR imaging study is an ominous sign or a usual feature in the natural evolution of SCI. This fundamental lack of knowledge is particularly limiting with regard to research aimed at preventing the secondary injury cascade. With an increasing number of therapies for SCI coming to trial, MR imaging can be expected to continue to be increasingly incorporated into research protocols for these agents. An understanding of the acute evolution of SCI lesions on MR imaging is essential if imaging is to be used effectively in these protocols. Additionally, the variability of SCI lesions with time, if demonstrated, would likely have a significant impact on efforts to correlate spinal cord lesion size and location to the neurologic level of injury, because prior studies have not systematically accounted for differences in time to imaging. Such variability currently limits the reliability of MR imaging to serve as an accurate predictor of the patient''s neurologic level and prognosis. This limitation is unfortunate in situations in which the MR imaging findings might be of particular utility, such as in the assessment of the obtunded patients or in patients not undergoing clinical evaluation at a specialized SCI center.To better understand the evolution of SCI lesions, we retrospectively studied how the time interval between trauma and MR imaging affects spinal cord lesion size in patients with similar neurologic deficits. We also directly measured cord edema changes in a small number of patients for whom short-term MR imaging follow-up was available.     

Cervical spinal stenosis with cord neurapraxia: evaluations and decisions regarding participation in athletics

Cervical spinal cord neurapraxia (CCN) leads to transient episodes ranging from paresthesia to paresis to plegia (complete paralysis), and occurs in athletes with some demonstrable degree of cervical spinal stenosis. Determination of spinal stenosis requires demonstrating a sagittal diameter of the spinal canal less than 14 mm from C4 to C6. Because radiologic techniques vary affecting the accuracy of this measure, a ratio method was developed comparing the spinal canal to the vertebral body width, demonstrating that a ratio of less than 0.8 is indicative of cervical spinal stenosis. Although this has high sensitivity (93%), the low predictive value of 0.2% makes this a poor screening tool for athletic participation. Further complicating the challenge of determining which athletes are at risk for quadriplegia are data showing that athletes who suffered permanent injury did not recall transient episodes of CCN, and conversely none of the athletes with CCN later developed permanent neurologic injury. Nevertheless, 56% of football athletes returning to sport after an episode of CCN experienced a recurrence as determined by survey data. Those with CCN and documented ligamentous instability, magnetic resonance imaging evidence of cord defects or swelling, neurologic symptoms or signs for greater than 36 hours, or more than one recurrence have an absolute contraindication.     

Female anal sphincter: age-related differences in asymptomatic volunteers with high-frequency endoanal US

PURPOSE: To evaluate endoanal ultrasonographic (US) anatomy in a large group of nulliparous women by using a high-frequency 10-MHz transducer to define normal age-related differences in sphincter morphology. MATERIALS AND METHODS: One hundred fifty asymptomatic nulliparous women (mean age, 31 years; range, 19-80 years) underwent endoanal US with a high-frequency 10-MHz transducer. Anal canal structures were measured at high, middle, and low levels and were correlated with age by using the Pearson simple linear correlation coefficient. RESULTS: Internal sphincter thickness showed a highly significant positive correlation with age at both sites at which it was measured (high anal canal, r = 0.34, P <.001; middle anal canal, r = 0.33, P <.001). External sphincter thickness showed a highly significant negative correlation with age at all sites measured (high anal canal, r = -0.65, P <.001; middle anal canal, r = -0.49, P <.001; low anal canal, r = -0.21, P =.012). There was no significant correlation between age and thickness of subepithelial tissue, longitudinal muscle, or puborectalis muscle. Subjects whose internal sphincter showed mixed echogenicity were significantly older than those whose internal sphincter was uniformly hypoechoic (mean, 47.4 vs 34.6 years; P <.001). Subjects with mixed internal sphincter echogenicity also had a significantly thinner external sphincter at high (mean thickness, 3.8 vs 4.6 mm; P <.001) and middle (mean thickness, 3.7 vs 4.1 mm; P =.03) anal canal levels. CONCLUSION: At older ages there are increased internal anal sphincter thickness and decreased external anal sphincter thickness. Diagnosis of external sphincter atrophy on the basis of sphincter thinning requires that one distinguish between abnormal thinning and age-related differences.     

Percutaneous translumbar spinal cord compression injury in dogs from an angioplasty balloon: MR and histopathologic changes with balloon sizes and compression times

BACKGROUND AND PURPOSE: Our previous model of spinal cord injury (SCI) included six dogs undergoing 30-minute compression with a balloon in the subarachnoid space. We determined whether various balloon sizes and compression times creates a gradation of injuries. METHODS: In 17 dogs (including our original six), angioplasty balloons 2, 4, or 7 mm in diameter (2 cm long) were inflated at T6 for 30, 120, or 240 minutes. T1- and T2-weighted, gadolinium-enhanced, and short-tau inversion recovery (STIR) MR images were obtained at 1.5 T. Spinal canal occlusion (SCO) was measured as balloon area-spinal cord area. Hematoxylin-eosin and beta amyloid precursor protein staining were performed to demonstrate hemorrhage and axonal injury, respectively. Injuries were scored as mild, moderate, or severe. Trends were assessed with one-way analysis of variance. RESULTS: SCO was 12.5-20% for 2-mm balloons, 28-56% for 4 mm, and 62-82% for 7 mm. No abnormalities were seen with SCO <30%. T1- and T2-weighted images had the poorest diagnostic performance; STIR images were best for predicting hemorrhage and axonal injury. Hemorrhage was demonstrated more frequently than was axonal injury. SCO (P < .0001) and hemorrhage (P = .002) significantly increased with balloon size. Longer inflation times tended to increase injuries for a given size, but differences were not significant. CONCLUSION: Compression injuries depended on the level of SCO. The compression times tested had less effect than the degree of compression. The value of 1.5-T MR imaging varied with the sequence and improved with contrast enhancement. STIR images showed SCIs not otherwise detected.     

Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils: predictors of immediate and long-term results with multivariate analysis 6-year experience

PURPOSE: To analyze anatomic and clinical results and factors predictive of outcome in treatment of basilar tip aneurysms with Guglielmi detachable coils (GDCs). MATERIALS AND METHODS: During 6 years, 55 unselected consecutive saccular aneurysms in 53 patients (mean age, 47 years) were treated with GDC occlusion. Forty-one (75%) aneurysms were ruptured (Hunt-Hess and Fisher grades were assigned in patients); 14 (25%), unruptured. Clinical and angiographic evaluations were performed 6 months after treatment and during follow-up (mean follow-up, 2 years). Multivariate analysis was used to determine factors predictive of outcome. RESULTS: GDC occlusion was a success in 52 (95%) aneurysms, a failure in two (4%), and not attempted in one (2%). Occlusion at final follow-up, evaluated in 44 aneurysms, was complete in 34 (77%), near complete in four (9%), and incomplete in six (14%). At 6-12 months, mean aneurysmal occlusion rate significantly worsened because of revascularization (P <.001) but improved at final follow-up because of reembolization in 10 aneurysms (P =.009); it remained stable (P =.351) between initial and final follow-up. Multivariate binary logistic regression indicated that before treatment started, aneurysmal neck size was the only independent predictor of initial occlusion rate (P =.002) and revascularization (P =.004). After the initial procedure, sac size and initial occlusion rate were independent predictors of revascularization (P =.004 and.008, respectively), irrespective of neck size. Occlusion rate at 6-12-month follow-up was the only independent predictor of that at final follow-up (P =.021), regardless of shape of aneurysm. Overall morbidity was 2% (one of 51); mortality, 6% (three of 51). Mortality correlated significantly with Hunt-Hess grade 4 at admission (P =.003) and incidence of vasospasm (P =.058). CONCLUSION: GDC occlusion proved to be a safe effective therapeutic alternative to surgery in patients with ruptured or unruptured basilar tip aneurysms. Morphologic and clinical factors were respectively identified as predictors of the optimal anatomic and clinical outcomes.     

颈、胸椎手术中医源性脊髓损伤的危险因素分析

目的 分析颈、胸椎手术中可能导致医源性脊髓损伤(iatrogenic spinal cord injury,ISCI)的危险因素,为减少手术中脊髓损伤提供理论依据。方法 回顾性调查2002年1月-2009年1月行颈、胸椎(C1～ T12)手术患者120例,按随机数字表法分为损伤组（34例）和对照组（86例）,对两组临床因素、影像学因素、手术和病理因素及可能的保护因素等共30个变量进行单因素分析,对差异有统计学意义的指标进行多因素非条件Logistic回归分析。结果 两组单因素比较显示,合并高血压、合并糖尿病、术前美国脊髓协会( ASIA)损伤分级、椎管狭窄率、脊髓／有效椎管面积比值、脊髓MRI T2W1高信号、术中出血量、椎管内突出物与硬膜粘连及术中使用甲基强的松龙( methylprednisolone,MP)等9个变量差异有统计学意义(P＜0.05)。Logistic回归分析显示合并糖尿病、术前ASIA损伤分级、脊髓／有效椎管面积比值、脊髓MRI T2W1高信号、术中出血量与ISCI呈正相关,术中使用MP与ISCI呈负相关。结论 合并糖尿病、ASIA损伤分级、脊髓MRI T2W1高信号、脊髓／有效椎管面积比值、术中出血量为ISCI的危险因素,术中使用MP对ISCI的发生有预防作用。     

Contralateral high-grade carotid artery stenosis or occlusion is not associated with increased risk for poor neurologic outcome after elective carotid stent placement

PURPOSE: To compare neurologic outcome after elective internal carotid artery (ICA) stents have been placed in patients with and in patients without contralateral ICA obstructions. MATERIALS AND METHODS: This study included 471 consecutive patients from a registry database who underwent elective ICA stent placement without cerebral protection for high-grade (greater than 70% stenosis of the ICA, according to the North American Symptomatic Carotid Endarterectomy Trial) symptomatic (n = 147) or asymptomatic (n = 324) ICA stenosis. Contralateral carotid arteries were investigated with angiography. Patients with and patients without contralateral high-grade stenosis (70%-99% stenosis, according to the North American Symptomatic Carotid Endarterectomy Trial) or occlusion were compared with respect to 30-day neurologic outcome by using the chi2 test and multivariate logistic regression analysis. RESULTS: Neurologic events were observed in 33 patients (7%) with 15 transient ischemic attacks, eight minor strokes, and 10 major strokes that led to death in two patients (combined stroke and death rate, 4%). Eighty-eight patients (19%) with contralateral high-grade ICA stenosis and 43 patients (9%) with contralateral ICA occlusion exhibited a similar rate of postintervention combined neurologic events (n = 9, 7%) compared with patients without contralateral high-grade ICA stenosis or occlusion (n = 24, 7%) (P =.94). No differences were observed between symptomatic and asymptomatic patients. Combined stroke and death rates were also comparable between symptomatic (four of 131, 3%) and asymptomatic (14 of 340, 4%) patients (P =.59). Of all variables tested, multivariate analysis did not detect any predictor for peri- or postinterventional neurologic events. CONCLUSION: Contralateral high-grade ICA stenosis or occlusion was not associated with an increased risk for neurologic events after elective ICA stent placement.     

CT findings and clinical features as markers for patient outcome in primary pontine hemorrhage

BACKGROUND AND PURPOSE: The overall mortality rate of primary pontine hemorrhage (PPH) in recent studies is 40-50%. The aim of the present study was to analyze the predictive value of clinical and neuroradiologic parameters concerning the outcome of patients with PPH. METHODS: We reviewed the clinical data of 29 consecutive patients (mean age, 59 +/- 13.5 years; 12 women, 17 men) with PPH. National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores were assessed on admission, and NIHSS, GCS, and Glasgow Outcome Scale (GOS) scores were assessed on discharge. The hemorrhage volume was calculated by using a previously published formula. Clinical manifestations, outcome, and volume and location of the bleeding were correlated. RESULTS: The mean GCS score on admission was 6.8 +/- 3.9 and increased to 9.0 +/- 3.9 on discharge. The NIHSS score improved from 29.1 +/- 12.5 to 12.1 +/- 7.3. Nine patients (31%) died as a result of PPH after 5 +/- 3 days. The mean GOS score was 3.0 +/- 1.5 (3.9 +/- 0.8 for patients who survived). Arterial hypertension was the most common risk factor (90%); other causes were anticoagulation therapy (7%) and amyloid angiopathy (3%). A high correlation was observed between a poor outcome (GOS score < 4) and hematoma volume greater than 4 mL (P =.006), ventral hemorrhage (P <.001), and necessity for mechanical ventilation (P <.001). Patients with dorsally located hematomas less than 4 mL in volume had a significantly better outcome. CONCLUSION: The prognosis of PPH is better than commonly expected. Most patients with moderate neurologic deficits on admission and dorsally located small hematomas are able to survive PPH with minor neurologic deficits.     

MR flow mapping in coronary artery bypass grafts: a validation study with Doppler flow measurements.

PURPOSE: To validate fast magnetic resonance (MR) flow mapping with intravascular Doppler flow measurements in vitro and in patients with nonstenotic and stenotic coronary artery bypass grafts. MATERIALS AND METHODS: MR and Doppler flow measurements were performed in a small-diameter flow phantom with physiologic flow conditions and at baseline and during adenosine stress in 27 grafts in 23 patients, who were scheduled for cardiac catheterization. At invasive analysis, the grafts were divided into those with stenosis of less than 50% (nonstenotic) and those with stenosis greater than or equal to 50% (stenotic). In vitro velocity values and velocity values in nonstenotic and stenotic grafts were compared with linear regression analysis, and the in vitro interstudy variability was determined. RESULTS: Excellent correlations in average peak velocity (r = 0.99, P <.001) and diastolic peak velocity (r = 0.99, P <.001) were demonstrated in vitro between MR and Doppler flow measurements, with less than 5% interstudy variability. MR and Doppler flow measurements revealed good correlations in peak velocity and velocity reserve both in nonstenotic (n = 20) (average peak velocity: r = 0.81, P <.001; diastolic peak velocity: r = 0.83, P <.001; velocity reserve: r = 0.56, P =.010) and stenotic (n = 7) (average peak velocity: r = 0.83, P <.001; diastolic peak velocity: r = 0.78, P =.001; velocity reserve: r = 0.70, P =.078) grafts. CONCLUSION: Fast MR flow mapping provides noninvasive measures of peak velocity and velocity reserve, which closely correlate with Doppler values both in vitro and in nonstenotic and stenotic grafts.     

经后路椎管减压椎弓根螺钉复位固定治疗中上胸椎骨折

目的 分析经后路减压复位固定治疗中上胸椎骨折的可行性及手术特点。 方法 对17例中上胸椎骨折患者进行回顾性研究,统计并发症的发生,比较手术前后脊髓完全性损伤和不完全性损伤的功能状态,观察脊髓无损伤患者有无医源性损伤。 结果 术后无手术并发症发生。不完全性损伤6例(不完全性损伤组),随访时美国脊髓损伤协会(ASIA)脊髓功能分级提高1～3级;完全性损伤8例(完全性损伤组),随访时ASIA分级无提高。完全性与不完全性损伤组手术前后感觉评分间差异有统计学意义(F =476.47,P=0.000)。手术前后运动评分之间差异有统计学意义(F=46.75,P =0.000)。脊髓功能正常3例,随访时ASIA分级无降低,感觉和运动评分无变化。 结论 对于中上胸椎骨折患者,后人路手术能避免加重胸部合并伤及其他组织系统的合并伤,可以在骨折早期安全、有效解除包括椎管前方的脊髓压迫,从而有利于脊髓功能的恢复。     

Sporadic lymphangioleiomyomatosis and tuberous sclerosis complex with lymphangioleiomyomatosis: comparison of CT features

PURPOSE: To retrospectively compare the frequencies of computed tomographic (CT) findings in patients with lymphangioleiomyomatosis (LAM) and patients with tuberous sclerosis complex (TSC) and LAM. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained for the HIPAA-compliant study. In 256 patients with LAM (mean age, 44 years) and 67 patients with TSC/LAM (mean age, 40 years), CT scans of the chest, abdomen, and pelvis were reviewed by a single radiologist. The fraction of lung involvement with cysts was estimated from high-spatial-resolution CT scans. Other findings assessed included noncalcified pulmonary nodules, pleural effusion, thoracic duct dilatation, hepatic and renal angiomyolipomas (AMLs), lymphangioleiomyoma (LALM), ascites, nephrectomy, and renal embolization. Confidence intervals and hypothesis tests of differences in frequencies, comparison of age quartiles, RIDIT analysis, analysis of variance, and correlation coefficients were used in the statistical analysis. RESULTS: Patients with LAM had more extensive lung involvement (RIDIT score, 0.36) and higher frequency of LALM (29% vs 9%, P<.001), thoracic duct dilatation (4% vs 0, P=.3), pleural effusion (12% vs 6%, P=.2), or ascites (10% vs 6%, P=.3). Patients with TSC/LAM had higher frequency of noncalcified pulmonary nodules (12% vs 1%, P<.01), hepatic (33% vs 2%, P<.001) and renal (93% vs 32%, P<.001) AMLs, nephrectomy (25% vs 7%, P<.001), or renal artery embolization (9% vs 2%, P<.05). CONCLUSION: The extent of lung disease is greater in LAM than TSC/LAM. Hepatic and renal AMLs and noncalcified lung nodules are more common in TSC/LAM, while lymphatic involvement-thoracic duct dilatation, chylous pleural effusion, ascites, and LALM-is more common in LAM.     

Cervical degenerative disease at flexion-extension MR imaging: prediction criteria

PURPOSE: To determine if there are any neutral-position imaging criteria that can help predict functional cord impingement at flexion-extension cervical magnetic resonance (MR) imaging. MATERIALS AND METHODS: Sixty-two patients with cervical degenerative disease were evaluated with regard to the dynamic changes of canal stenosis at flexion-extension MR imaging. Functional cord impingement was considered if the cord was impinged or more impinged after neck flexion or extension. Selection criteria for neutral-position MR imaging, such as cervical curvature, canal space, degenerative stage, intramedullary high signal intensity on T2-weighted images, and resting instability, were evaluated for their ability to predict functional cord impingement at flexion-extension MR imaging (Fisher exact test, logistic regression analysis). RESULTS: MR images in 19 (31%) of 62 patients showed functional cord impingement at extension MR imaging compared with images in two (3%) patients at flexion MR imaging. Statistically significant differences were found for the criteria cervical degeneration stage (P <.001) and spinal canal space (P =.037) for predicting functional cord impingement at extension MR imaging. In contrast, no significant differences were found among selection criteria for flexion MR imaging. Probabilities of functional cord impingement at extension MR imaging were calculated with different combinations of degenerative stages and canal spaces. Probability could increase to 79% if the patient had both stabilization degeneration (disk protrusion or osteophytic formation with hypertrophy of the ligamentum flavum) and C7 canal space of 10 mm or less. CONCLUSION: None of the selection criteria evaluated in this study has the ability to predict functional cord impingement at flexion MR imaging; however, prediction of impingement at extension MR imaging can increase from 31% to 79% if proper criteria are selected.     

The relationship between the functional abilities of patients with cervical spinal cord injury and the severity of damage revealed by MR imaging.

BACKGROUND AND PURPOSE: The appearance of the damaged spinal cord after injury correlates with initial neurologic deficit, as determined by the American Spinal Injury Association grade and manual muscle test score, as well as with recovery, as assessed by manual muscle test scores. The purpose of this study was to determine whether the presence of spinal cord hemorrhage and the size and location of spinal cord edema on MR images is predictive of functional recovery in survivors of cervical spinal cord injury (SCI). METHODS: The degree of damage to the cervical spinal cord was measured on the MR images of 49 patients who underwent imaging within 72 hours of sustaining SCI. The effects of hemorrhage and length/location of edema on changes in the value of the motor scale of the functional independence measure (FIM) were assessed on admission to and discharge from rehabilitation. RESULTS: Patients without spinal cord hemorrhage had significant improvement in self-care and mobility scores compared with patients with hemorrhage. There was no significant effect of spinal cord hemorrhage on changes in locomotion and sphincter control scores. The rostral limit of edema positively correlated with admission and discharge self-care scores and with admission mobility and locomotion scores. Edema length had a negative correlation with all FIM scales at admission and discharge. CONCLUSION: The imaging characteristics of cervical SCI (hemorrhage and edema) are related to levels of physical recovery as determined by the FIM scale. Imaging factors that correlate with poor functional recovery are hemorrhage, long segments of edema, and high cervical locations.     

Relationship between transcranial Doppler and CT data in acute intracerebral hemorrhage

BACKGROUND AND PURPOSE: It would be useful to have a noninvasive test for correlation with CT findings in patients with intracerebral hemorrhage (ICH). We determined which transcranial Doppler (TCD) variables are related to which CT data in patients with ICH. METHODS: We prospectively included 51 patients (age +/- SD, 66.2 +/- 12.4 years; 30 men, 21 women) with first-ever supratentorial, nontraumatic ICH. CT and TCD examination were performed in the acute stage (less than 12 hours from symptom onset). TCD recordings were obtained from the middle cerebral arteries, and the following variables were analyzed: systolic (Vs), diastolic (Vd), mean (Vm) velocities, and pulsatiliy index from the affected (a) and unaffected (u) hemispheres. RESULTS: PIs obtained for both hemispheres were positively correlated with hematoma volume (aPI, r=0.43, P=.001; uPI, r=0.44, P=.001), volume of hypoattenuation (aPI r=0.64, P <.0001; uPI, r=0.39, P=.005), total volume (aPI, r=0.59, P <.0001; uPI, r=0.48, P <.0001), and midline shift (aPI, r=0.28, P=.04; uPI, r=0.29, P=.03). Both PIs were increased in patients with intraventricular hemorrhage (aPI, P=.01; uPI P=.004). No TCD parameter was correlated with ventricular size. CONCLUSION: Most TCD parameters were correlated with CT data in the acute stage of ICH. An increase in PI probably reflects intracranial hypertension and mass effect. Further studies are needed to determine the clinical application of our findings.