无创性脊髓血管成像诊断脊髓血管畸形的临床应用价值  

Clinical application and diagnostic value of non-invasive spinal angiography in spinal vascular malformations

作　　者：曹际斌[1] 高思佳[1] 李燕燕[3] 崔玲玲[1] 蒋旭远[1] 韩鹏[2] 

机构地区：[1]中国医科大学附属第一医院放射科,沈阳110001 [2]中国医科大学附属第一医院神经外科 [3]第四军医大学唐都医院放射科

出　　处：《中华放射学杂志》2012年第5期430-434,共5页Chinese Journal of Radiology

摘　　要：目的通过与脊髓DSA及手术对比，初步探讨256层MSCT全脊髓血管成像（CTA）及3．0TMR脊髓血管动态增强扫描（CE—MRA）诊断脊髓血管畸形的临床应用价值。方法17例临床表现及MR平扫疑诊为脊髓血管病的患者，全部行CTA检查，其中10例行MRA检查，15例在CT或MR检查3—5d后行DSA检查，8例患者经手术治疗。将其CTA、MRA、DSA及手术结果进行对比。结果行CTA检查的17例患者中，16例较好地显示了异常血管病变的范围，其中7例诊断为硬脊膜动静脉瘘，7例为髓周动静脉瘘，2例为脊髓动静脉畸形，与DSA或手术诊断一致，1例无法做出诊断。其中12例准确判定供血动脉，12例准确显示瘘口位置。行MRA检查的10例患者中，7例准确诊断供血动脉及瘘口位置，与DSA或手术结果一致；其余3例DSA检查阴性。结论256层MSCT全脊髓CTA及3．0TMRCE—MRA能安全、无创、快速、清晰地显示脊髓血管畸形的病变范围、供血动脉及瘘口的位置，缩短DSA诊疗时间，在脊髓血管畸形的诊断、协助制订治疗方案及术后随访方面起到重要作用。Objective To explore the value of CT spinal angiography with 256 MSCT and fast dynamic contrast-enhanced 3D MR angiography （ CE-MRA ） at 3.0 T in the diagnosis of spinal vascular malformations by comparing with results of DSA and operation. Methods Seventeen patients suspected of spinal vascular diseases by initial MR and clinical manifestations all underwent CT spinal angiography. Of them, 10 patients underwent MRA, 15 patients underwent DSA within 3--5 days, and 8 patients finally underwent surgical treatment. Results CTA examination clearly showed the abnormal vascular lesions in 16 of 17 cases, including 7 cases with the diagnosis of spinal dural arteriovenous fistula, 7 cases of perimedullary arteriovenous fistula, and 2 cases of spinal arteriovenous malformations. The results were consistent with the diagnosis of DSA or surgery. One case was poorly diagnosed. The feeding vessels were correctly determined in 12 cases, and the level of fistulas were correctly displayed in 12 cases. The level of fistulas and feeding vessels were accurately showed in 7 of 10 cases with MRA, while the other 3 cases exhibited normal with DSA. Conclusions Spinal angiography with 256 MSCT and CE-MRA at 3.0 T can clearly show the extent of spinal vascular malformations, feeding arteries and fistula location. They are safe, noninvasive, convinient and can shorten the time of DSA diagnosis and treatment. They play an important role in diagnosis and treatment of spinal vascular malformations and postoperative follow-up.

关 键 词：脊髓血管疾病 磁共振成像 体层摄影术 X线计算机 血管造影术 数字减影 

分 类 号：R744.1[医药卫生—神经病学与精神病学]