Chronic spinal subdural haematoma associated with intracranial subdural haematoma: CT and MRI

Chronic spinal subdural haematoma is a uncommon. We describe the CT and MRI appearances of chronic spinal and intracranial subdural haematomas following minor trauma. The aetiology, pathogenesis and differential diagnosis are discussed. Received: 7 January 1998 Accepted: 15 July 1998     

Isodense subdural haematomas on CT: MRI findings

Summary MRI findings are described in two patients with subdural haematomas isodense on CT. In one patient, admitted 6 weeks after trauma, a chronic subdural haematoma showed extreme hypointensity on T2-weighted images, suggesting acute trauma, and therefore acute rebleeding. In the second patient with severe anaemia, an acute subdural haematoma was hyperintense on T2-weighted images, suggesting chronic trauma; this may be explained by the low haematocrit and a possible mixture of blood with cerebrospinal fluid. The MRI features of subdural haematomas and hygromas have to be kept in mind, in order not to misjudge the age of the haematoma.     

自发性椎管内硬膜外血肿的MRI诊断

目的探讨自发性椎管内硬膜外血肿（SSEH）的MRI特征,旨在提高对此病的认识水平。方法回顾性总结我院6例SSEH的MRI特征和相关临床资料,其中4例经手术和病理确诊,2例保守治疗随访有效。结果血肿位于颈胸段2例,胸段3例,腰段1例。5例血肿位于硬脊膜外腔后方,1例位于硬脊膜外腔侧后方,血肿累及l～3个脊髓节段。T1加权像呈等信号、Tz加权像呈高信号1例;T1加权像呈等信号、L加权像呈低信号3例;T1加权像呈高信号、T1加权像呈低信号2例。其中4例采用钆喷酸葡甲胺（Gd—DTPA）对比剂增强扫描,1例轻中度条片状强化;2例边缘轻度强化,其中1例类似环状;1例无明显强化。结论MRI易于检出自发性椎管内硬膜外血肿,可以准确显示其部位、形态、大小及周围组织的关系,可以作出定性诊断,对临床诊治具有重要价值。     

MRI of spinal epidural lymphoma

We reviewed the MRI features in eight patients with spinal epidural lymphoma (clinically primary in 4 patients); one patient had multiple lesions. The cervical spine was involved in one patient, the thoracolumbar spine in 5 and the sacrum in two. Mean longitudinal extension of the epidural lesion was 2.6 vertebral segments. The tumours were homogeneously isointense with the spinal cord on T1-weighted images and isointense or hyperintense on proton-density and T2-weighted images. The spinal cord was compressed in four patients but showed signal changes in only one. In five patients the lesions communicated through the intervertebral formaina with paravertebral soft tissue masses. In all but one of the patients diffuse signal changes in the vertebral body marrow consistent with osteolytic or osteobalstic changes were identified adjacent to or at distance from the epidural lesion. Vertebral collapse was observed in two patients.     

术中不同钻孔部位对慢性硬膜下血肿疗效的影响

目的探讨慢性硬膜下血肿术中不同钻孔部位对疗效的影响。方法将2010年11月～2012年10月收治的慢性硬膜下血肿患者作为治疗组,2008年11月～2010年10月收治的患者作为对照组,共49例。治疗组选择血肿最大层面中间点作钻孔点,对照组选择血肿最大层面中近顶结节处作钻孔点,比较两组患者术后残余积气量、积液量及术后复发率。结果与对照组相比,治疗组术后颅内积气、积液量少,复发率低。结论选择血肿最大层面中点作钻孔点效果更好,术中操作更方便。     

脊柱单发性浆细胞骨髓瘤的MRI表现

目的探讨脊柱单发性浆细胞骨髓瘤的MRI表现。方法回顾性分析我院2007年10月～2012年1月间经手术及病理证实的MRI诊断脊柱单发性浆细胞骨髓瘤4例。结果 4例均发生在腰椎,MRI影像中椎体均出现溶骨性骨质破坏,2例椎体后缘骨质破坏伴软组织肿块,2例椎体后缘骨质无明显破坏但合并的椎旁软组织肿块导致椎管狭窄,3例累及椎体附件,4例椎体轻度压缩骨折。结论脊柱单发性浆细胞骨髓瘤MRI上有较典型软组织肿块及骨质破坏特点,有助于与其他单发脊柱肿瘤鉴别,MRI检查可提高诊断准确性。     

MRI of spinal cord and vertebral body infarction in the anterior spinal artery syndrome

We describe the temporal sequence of signal changes in the spinal cord and vertebral column following vascular damage caused by ethanol injected during surgery.     

特发性椎管内硬膜外脂肪增多症的MRI与临床诊断

目的：探讨特发性椎管内硬膜外脂肪增多症的MRI与临床表现。方法：收集特发性椎管内硬膜外脂肪增多症12例。回顾性分析术前MRI及其它影像表现。结果：特发性椎管内硬膜外脂肪增多症的MRI表现有以下特征：（1）椎管内背侧硬膜外过多的脂肪沉积。（2）沉积的脂肪呈连续的棱带状。（3）硬膜囊背侧受压。（4）脊髓受压,所作X线检查椎管内未见异常,部分脊髓造影示通过不畅。所作CT检查可见过多沉积的脂肪,但不能显示脊髓的受压等表现。结论：特发性椎管内硬膜外脂肪增多症的MRI在病灶的部位、形态、信号及其对周围组织的影响等方面均有规律可循,且MRI优于其它影像学检查,为临床诊断及治疗提供依据。     

脊柱包虫病的MRI表现

圆形.病变可累及椎管、附件和邻近软组织.囊性病灶在T1WI呈低信号,T2WT呈高信号.囊性病灶内见多发大小不等的子囊影,并在T2WI上见低信号的包虫囊壁.T2脂肪抑制序列及脊髓水成像技术对病变的显示具有优势.增强扫描可呈轻度强化.灌注成像中呈现中等灌注改变.结论 MRI可清楚显示椎体、椎管、附件及邻近软织的包虫囊肿,对脊柱包虫病的诊断具有独特优势.     

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。     

MRI of intracerebral haematoma at low field (0.15T) using T2 dependent partial saturation sequences

Summary Results of MRI at 0.15T in twelve successive patients with intracerebral haematoma are reviewed. Using T₂ weighted spin echo (SE) and partial saturation (PS without a refocussing 180° pulse) sequences, low intensity areas were seen in eleven of the twelve cases. These included central regions (three cases), a peripheral rim (seven cases) and more diffuse patterns involving the brainstem and cerebral hemispheres (two cases). One case initially displayed a peripheral rim and later a central low intensity region. Central low intensity regions were seen in acute, subacute, and chronic cases. Follow up in five cases displayed an increase in signal within the haematoma in three cases and a decrease in signal intensity in two cases. Low signal intensity areas can be seen within and around intracerebral haematomas imaged with T₂ weighted sequences at low field strength.     

Spontaneous spinal epidural haematomas with repeated remission and relapse

We present a case of spontaneous spinal epidural haematoma (SSEH) with a rare clinical course of repeated spontaneous recovery and relapse. The patient suffered three episodes of upper-back pain of sudden onset followed by sensory and motor dysfunction after weight lifting. In the first two episodes, the neurological deficits recovered spontaneously and completely. In the last episode, paraplegia persisted even after emergency surgery. Serial studies with computed tomographic (CT) myelography and magnetic resonance imaging (MRI) demonstrated the remitting and relapsing course of the SSEHs. The possible causes of the SSEHs and the mechanisms of spontaneous recovery are discussed. Received: 30 April 1996 Accepted: 12 November 1996     

脊椎结核的低场MRI诊断及临床应用

目的：探讨MRI对脊椎结核的诊断及临床应用价值。方法：对51例X线平片诊断或疑似脊椎结核的患者均进行MRI常规T2WI、T1WI及STIR扫描,以及部分病例进行增强扫描,并进行手术病理结果对照。结果：在51例中,43例X线平片诊断为结核（84．3％）,所有病例在MRI均能正确诊断（100％）,病灶区T1硼上多呈低信号,少部分呈混杂信号,T2WI上多呈不均匀较高信号,脓肿灶呈T1WI低、T2WI高信号。结论：MRI能准确显示病灶的大小和侵犯的范围,尤其是在椎旁寒性脓疡的显示准确性明显优于CT和X线,我们认为MRI对脊椎结核的诊断准确性高,且能早期诊断,应作该病治疗前的常规检查。     

髓外硬膜下肿瘤的MRI诊断及鉴别诊断

目的:分析评价髓外硬膜下肿瘤的MRI表现及影像学特征,提高诊断与鉴别诊断水平。方法:收集经MRI检查手术病理证实的髓外硬膜下肿瘤58例,对其MRI表现及影像学特征进行回顾性分析。结果:58例髓外硬膜下肿瘤中,神经鞘瘤24例,神经纤维瘤18例,脊膜瘤8例,脂肪瘤5例,畸胎瘤3例,各种不同肿瘤的MRI征象,都各有其特征性。结论:髓外硬膜下肿瘤MRI检查是首选方法、定位、定性诊断及鉴别诊断均有重要价值。     

The MRI signs of spinal arachnoid diverticula

Our goal was to find MRI signs of use for identifying a spinal arachnoid diverticulum. Three cases of spinal arachnoid diverticula, one extradural and two intradural, were examined on a 1.5 T imager. There was obvious mass effect on the adjacent structures in one case and increased signal intensity in the diverticulum on proton density- and T2-weighted images in two cases. Signal changes due to turbulent movement of the spinal fluid inside the diverticula were seen in all cases on sagittal fast spin-echo (FSE) proton density- and T2-weighted images; it was difficult to tell whether these signal changes imply a communication or are simply FSE artefacts. On contrast-enhanced studies, all cases showed partial enhancement inside the diverticula. There thus are four signs of diverticula: mass effect, the increased signal, signal void sign and partial enhancement; the last of these, the most reliable, has never been reported before. Received: 22 December 1995 Accepted: 26 July 1996     

Age determination of subdural hematomas with CT and MRI: A systematic review

Objectives

To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans.

Methods

We performed a systematic review in MEDLINE, EMBASE and Cochrane to search for articles that described the appearance of SDHs on CT or MRI in relation to time between trauma and scanning. Two researchers independently screened the articles, assessed methodological quality and performed data extraction. Medians with interquartile ranges were calculated. Differences were tested with a Mann–Whitney U or Kruskal–Wallis H test.

Results

We included 22 studies describing 973 SDHs on CT and 4 studies describing 83 SDHs on MRI. Data from 17 studies (413 SDHs) could be pooled. There were significant differences between time intervals for the different densities on CT (p < 0.001). Time interval differed significantly between children and adults for iso- and hypodensity (p = 0.000) and hyperdensity (p = 0.046). Time interval did not differ significantly between abused and non-abused children. On MRI, time intervals for different signal intensities on T1 and T2 did not differ significantly (p = 0.108 and p = 0.194, respectively).

Conclusions

Most time intervals of the different appearances of SDHs on CT and MRI are broad and overlapping. Therefore CT or MRI findings cannot be used to accurately date SDHs.     

Acute traumatic spinal epidural hematoma: imaging and neurologic outcome

The purpose of this study was to present MRI characteristics of traumatic spinal epidural hematomas (TSEHs) and to evaluate their effect on neurologic outcome. A retrospective analysis was performed of all 74 cases in which patients underwent emergent spinal MRI in the setting of acute trauma at our institutions Emergency Department between June 2002 and January 2003. MRI studies were evaluated for the presence of a TSEH. CT studies were evaluated for the presence of osseous trauma. Patient data were collected from medical records on the initial neurologic status at admission and at 6 months after injury. Twenty-seven of 74 patients had a spinal fracture and a TSEH. Twenty-five of 74 patients had a spinal fracture with no TSEH. Twenty-two of 74 patients had normal imaging studies. Six-month follow-up of neurologic status demonstrated no statistically significant difference in neurologic outcome between patients with spinal fractures and TSEH and those with spinal fractures but no TSEH. If a spinal fracture and abnormal neurologic exam are present, the neurologic outcome at 6 months is not worsened by the presence of a TSEH.     

慢性硬脑膜下血肿的MRI表现

本文总结了14例经手术证实的慢性硬脑膜下血肿的磁共振成像(MRI)表现。在MRI的T_1和T_2加权成像上,慢性硬脑膜下血肿均表现为高信号,结合文献讨论了慢性硬脑膜下血肿短T_1和长T_2表现的机理。结果表明,在诊断慢性硬脑膜下血肿上,MRI较CT扫描更为优越。     

脊柱转移瘤的MRI诊断(附34例分析)

目的：探讨MRI对脊柱转移瘤诊断和鉴别诊断的价值。方法：回顾性分析34例脊柱转移瘤的MRI表现，均有明确原发瘤灶。结果：①6例为单椎体病变，28例为多椎体病变；②在T1WI上34例均呈低信号，在T2WI上26例(76．5％)呈高信号，7例(20．6％)呈等信号，1例(2．9％)呈低信号；③椎体骨质破坏分溶骨型、成骨型、混合型三种类型；④椎旁肿块形成者7例(20．6％)；⑤椎管狭窄者13例(38．2％)；⑥跳跃式分布者20例(59．9％)；⑦34例椎间盘的形态及信号均大致正常。结论：脊柱转移瘤具有特征性的MRI表现，综合分析有助于诊断和鉴别诊断。