脊膜脊髓结核23例核磁共振影像分析  

Analysis on 23 Cases of Spinal Meningeal Tuberculosis by Magnetic Resonance Imaging

作　　者：王东坡[1] 吕岩[1] 周新华[1] 贺伟[1] 吕平欣[1] 

机构地区：[1]首都医科大学附属北京胸科医院医学影像科,101149

出　　处：《结核病与胸部肿瘤》2016年第2期108-112,共5页Tuberculosis and Thoracic Tumor

摘　　要：目的分析脊膜脊髓结核的核磁共振（MRI）影像特点。方法回顾性分析我院2011年6月至2014年10月收治的23例脊膜脊髓结核病例的MRI影像表现，男12例，女11例，年龄16—50岁，中位年龄为26岁；并与25例脊膜转移癌的MRI表现进行对照，男18例，女7例，年龄44～78岁，中位年龄56岁。所有病例均行MRI平扫和增强检查。计数资料采用）（。检验，计量资料采用t检验，P〈0．05为差异有统计学意义。结果23例脊膜脊髓结核中，单纯脊膜结核16例，脊膜脊髓结核7例。MR影像表现：（1）脊膜结核：脊膜（硬脊膜、蛛网膜及软脊膜、不规则线状、条带状及丘状增厚，增强扫描可见强化（23／23），厚度〈5mm，累及长度平均为7个椎体节段，增强扫描可见强化（23／23），同时5例脊膜合并簇状或者串珠状排列的环形强化结节；蛛网膜下腔不规则狭窄（23／23），少部分合并局部闭塞（5／23）；蛛网膜下腔不均质异常信号（20／23）；脑脊液脊髓交界面毛糙、不光滑（10／23）；继发性蛛网膜囊肿形成（15／23）；（2）脊膜脊髓结核：在脊膜结核影像表现的基础上合并脊髓内病变（7／23），其中结节4例呈典型的环形强化，3例小斑块呈不均匀强化。脊膜脊髓转移癌25例，其中脊膜转移癌20例，同时合并髓内转移结节5例。脊膜转移癌表现为结节状增厚8例、斑块状增厚10例和两者同时存在7例，其中19例为连续性增厚，平均长度为3个椎体节段，6例为多发局限增厚，增强扫描示增厚脊膜均见明显强化，髓内结节呈不均匀强化。结论脊膜脊髓结核的MRI表现有脊膜连续性增厚、继发性蛛网膜囊肿、脑脊液一脊髓交界面毛糙以及结核结节串珠样排列等特点，密切结合临床及原发疾病有助于诊断及鉴别诊断。Objective To explore the imaging features of spinal cord and spinal meningeal tuberculosis by magnetic resonance （MR）. Methods We analyzed retrospectively the features of MRI in 23 patients with spinal cord and spinal meningeal tuberculosis compared to 25 patients with spinal cord meningeal metastatic carcinoma. All patients were admitted in our hospital from Jun. 2011 to Oct. 2014. There were 12 males and 11 females with a median age of 26 （range 16-50） years in the spinal cord meningeal tuberculosis group, and 18 males and 7 females with a median age 56 （range 44- 78） years in the spinal cord meningeal metastatic carcinoma group. All patients underwent MR plain and contrast-enhanced scanning. The enumeration data were compared with the X 2 test and the measurement data were compared with t test. The difference was considered statistically significant when the P value was 〈0.05. Results Of the 23 cases, 16 were spinal meningeal tuberculosis and 7 were spinal cord tuberculosis. The MR imaging features were as follows： （1）Spinal meningeal tuberculosis： Irregular and linear strip and hummocky thickening （thickness 〈5 mm） of the meninges （dura, arachnoid and pia mater）, with the average length of involvement of 7 vertebral segments. Enhancement was present in all cases by contrast-enhanced scanning, including clustering or moniliform enhancement in 5 cases. Subarachnoid irregular stenosis was seen in all cases, partial occlusion in 5, abnormal heterogeneous signal in 20, rough cerebrospinal fluid （CSF）-spinal interface in 10, and formation of secondary arachnoid cyst in 15. （2）Spinal cord meningeal tuberculosis： of the 7 cases, 4 showed ring enhancement and 3 showed small plaque with heterogeneous enhancement.（3）There were 20 cases of meningeal metastatic carcinoma and 5 cases of meningeal metastatic carcinoma with spinal cord metastasis. Nodular thickening was present in 8 cases, plaque thickening in 10, and nodular and plaque thickening in 7. Continuous thickening invo

关 键 词：脊膜 结核 磁共振波谱学 

分 类 号：R529.2[医药卫生—内科学]