椎管内结核性蛛网膜炎的MR成像

目的评估ＭＲＩ对椎管内结核性蛛网膜炎的诊断价值。材料与方法对１６例椎管内结核性蛛网膜炎的ＭＲＩ表现、Ｇｄ－ＤＴＰＡ增强ＭＲＩ的作用和追踪ＭＲＩ的变化进行分析。结果ＭＲＩ显示脊膜炎１２例，表现为蛛网膜下腔狭窄和消失、脑脊液分房和神经根增厚。在增强ＭＲＩ上，受累的软脊膜和硬膜呈线形、弥漫性斑块状和结节状或环形显著增强。脊髓受累见于全部１６例，包括脊髓水肿９例；脊髓空洞７例。在全部１６例中，髓内结核瘤２例。结论ＭＲＩ可以直接显示脊膜、脊髓和神经根受累后的形态学和病理学改变，增强ＭＲＩ可以更清楚地显示出髓内和髓外病变的程度。因此，ＭＲＩ对椎管内结核性蛛网膜炎的诊断价值，无论是在急性期或慢性粘连期，均优于脊髓造影和ＣＴ脊髓造影

MR imaging of spinal tuberculous arachnoiditis

Purpose To evaluate the diagnostic role of MR imaging in spinal tuberculous arachnoiditis. Materials and methods The MRI features of serial non enhanced and Gadolinium enhanced MR imaging in 16 patients with tuberculous arachnoiditis of the spine were analyzed. Results Leptomeningitis was found by MR imaging in 12 cases. The appearances of non enhanced MR imaging were characterised by obliteration of subarachnoid space, loculation of cerebralspinal fluid and thickening of nerve roots. On Gadolinium enhanced MR images, linear, diffuse plaque like and nodular enhancement on the surface of the spinal cord and the dura arachnoid complex were demonstrated. Intramedullary lesion was revealed in all of 18 cases, including cord edema in 9, cavitation in 7, and tuberculoma 2. Conclusion It is possible to demonstrate directly the morphological and pathological changes of the spinal cord leptomeninges and nerve roots on non enhanced MR imaging while contrast enhanced MRI can better delineate the extent of intra and extra medullary lesions. Therefore, MR examination should be the modality of choice in screening of patients with suspected spinal tuberculous arachnoiditis.