儿童髓外硬膜下结核球的临床特点及其MRI诊断  

Clinical features and MRI diagnosis of intradural extramedullary tuberculomas in children

作　　者：秦勇[1] 蔡金华[1] 兰秀夫[2] 

机构地区：[1]重庆医科大学附属儿童医院放射科,重庆400014 [2]第三军医大学附属大坪医院骨科,重庆400042

出　　处：《中国医学影像技术》2011年第7期1366-1369,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨儿童髓外硬膜下结核球（IET）的临床特点及MRI表现。方法回顾性分析7例经手术及组织病理学证实IET患儿的临床资料和MRI表现。结果 7例患儿均有其他部位结核病史,临床主要表现为不同程度的进行性肢体瘫痪及感觉功能障碍、尿潴留或尿失禁等脊髓压迫症状。3例初发症状出现于抗结核治疗后3个月以内,1例出现于4~6个月,3例出现于7~9个月。MR平扫及增强扫描发现全部IET,病灶呈长梭形或扁豆状位于椎管内脊髓后方纵向走行,T1WI呈稍低信号或等信号,T2WI呈等信号或混杂高信号,增强后病灶呈均匀或不均匀明显强化。结论 IET可能是机体对抗结核药物治疗所发生的矛盾反应的结果,MR检查特别是增强扫描可清楚显示病变的范围、形态和信号特点,结合临床可及时、准确诊断IET。Objective To investigate the clinical and MRI features of intradural extramedullary tuberculoma（IET） in children.Methods The clinical data and MRI findings in 7 children with IET confirmed with surgery and pathology were analyzed retrospectively.Results All 7 children of IET had the history of tuberculosis in other organs.The main clinical manifestations were progressive paresis and sensory disturbance in extremities accompanying with urinary retention or urinary incontinence,which were caused by spinal compression.The compressive myelopathy was first discovered within 3 months in 3 cases,4—6 months in 1 case,and 7—9 months in 3 cases respectively after initiation of antituberculous chemotherapy.All the tuberculomas were detected with plain and enhanced MR scanning.The lesions showed longitudinal fusiformis or bean-shaped,and located posterior to the spinal cord,with a high incidence of thoracic segments.The spinal cord segments corresponding to the lesions were compressed to different degree.The tuberculomas presented with hypointensity or isointensity on T1WI,and isointensity or inhomogeneous hyperintensity on T2WI.All lesions showed homogeneously or inhomogeneously marked enhancement after injection of gadolinium.Conclusion IET may occur as a result of paradoxical response to antituberculous therapy.MRI,especially contrast enhanced scanning,can clearly reveal the range,shape and signal characteristic of the tuberculoma.MRI combined with clinical features can lead to a prompt and correct diagnosis for IET.

关 键 词：结核球 磁共振成像 儿童 

分 类 号：R521.9[医药卫生—内科学] R445.2[医药卫生—临床医学]