常见脊髓非肿瘤性病变的MRI 诊断及鉴别诊断  

MR imaging diagnosis and differential diagnosis of routine non-neoplastic lesions in the spinal cord

作　　者：包发秀 王渊[1] 代勤[1] 毛翠平[1] 王红梅[1] 郭丽萍[1] 李文菲[1] 张明[1] 

机构地区：[1]西安交通大学医学院第一附属医院影像科,陕西西安710061

出　　处：《实用放射学杂志》2014年第6期901-903,942,共4页Journal of Practical Radiology

摘　　要：目的：分析常见脊髓非肿瘤性病变的 MRI 表现及鉴别诊断要点。方法回顾性分析本院28例脊髓非肿瘤性病变的临床和 MRI 资料，总结其 MRI 特征。结果28例患者中急性脊髓炎5例、脊髓多发性硬化16例、视神经脊髓炎4例、脊髓亚急性联合变性1例、脊髓梗死2例。所有病例 MRI 信号相似，均为 T1 WI 等或稍低、T2 WI 高信号，急性脊髓炎常累及5个以上椎体节段，脊髓均匀性肿胀；脊髓多发性硬化受累范围一般〈2个椎体节段，病变小于横截面积的1/2；视神经脊髓炎累及3个以上椎体节段，累及大部分灰质和部分白质；脊髓亚急性联合变性病变位于脊髓后部，轴位 T2显示对称性分布于后索或侧索；脊髓梗死可累及1至数个椎体节段，局限在脊髓前2/3区域，形成“猫头鹰眼征”。结论常见脊髓非肿瘤性病变的 MRI 表现有一定特征性，结合病变的形态、累及范围及临床资料有助于定性诊断。Objective To analyze magnetic resonance imaging （MRI）features and differential diagnosis of non-neoplastic lesions in the spinal cord.Methods Clinical manifestations and MRI data of 28 patients with non-neoplastic lesions in the spinal cord were analyzed retrospectively.Results Of the 28 cases,5 cases were acute myelitis,1 6 were multiple sclerosis,4 were neuromyelitis optica,1 case was subacute combined degeneration of spinal cord and 2 cases were spinal cord infarction.The MR signal intensity of the spinal cord lesions in all patients are similar presenting as isointensity or slight hypointensity on T1 weighted images and hyperintensity on T2 weighted images.In our study,both gray matter and white matter were involved in acute myelitis and the size is about more than 5 vertebral segments.For multiple sclerosis,the lesions were less than 2 vertebral segments in length and occupy 1/2 of the spinal cord in cross-sectional view.The neuromyelitis optica invade most of the gray matter and part of the white matter,and more than 3 vertebral segments.For subacute combined degeneration of spinal cord,the lesions were located in the posterior and lateral funiculus of the spinal cord presenting as a longitudinal belt in the sagittal view,which showed homogenous hyperintense in the axial T2 weighted images.The “owl eye sign”will occur in spinal cord infarction,including one to several vertebral segments and being confined to two-third ventral region of the spinal cord.Conclusion Non-neoplastic lesions in spinal cord have specific characteristics in MR imaging.Combination of the involved vertebral segment,size of the lesions and clinical manifestations will help to make an accurate diagnosis.

关 键 词：磁共振成像 急性脊髓炎 脊髓多发性硬化 视神经脊髓炎 脊髓亚急性联合变性 脊髓梗死 

分 类 号：R445.2[医药卫生—影像医学与核医学] R745.4[医药卫生—诊断学]