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.

MRI Diagnosis of Spinal Cord Vascular Lesions

Objective Summarize the Magnetic resonance imaging of the spinal cord vascular lesions to improve the diagnosis. Materials and Methods Imaging data of 33 patients with spinal cord vascular lesions proved by pathology or DSA were reviewed retrospectively. Of the 33 cases, 11 cases were cavernous hemangioma (8 intramedullary cavernous hemangioma, 3 extradural cavernous hemangiomas), 4 cases were hemangioblastoma (2 single , 2 multiple), and 18 cases were arteriovenous lesions (12 arteriovenous fistula, 6 arteriovenous malformation ). All the patients underwent MRI and contrast MR imaging. Results Most patients with spinal cord vascular lesions were around 40 ages and presented with a slowly progressive neurological decline. Intramedullary Cavernous hemangioma were more common than extramedullary Cavernous hemangioma. and more frequent localized in the cervical regions with a typically low signal intensity around the lesion on T2WI. They often had no significant enhancement. Purely extradural cavernous hemangiomas of the spinal canal were extremely rare. The most common location was the thoracic region. These tumors were usually well delineated as fusiform tumor, enhance avidly and homogenously. Spinal hemangioblastomas were uncommon and may be single or multipule. They usually occurred in the cervical and thoracic region. The typical MR appearances were large intramedullary cyst or hollow with mural nodule enhancement. Arteriovenous lesions were most common and could be easy to diagnosis when MRI showed serpentine flow voids. But correct typing was depended on DSA or surgery findings. Conclusion Various groups of spinal cord vascular lesions have characteristic MRI features respectively. MRI can identify the lesion and detect the region and extent of spinal cord degeneration, which is useful to diagnosis, therapy and prognosis.