脊髓MRI对多发性硬化的诊断和鉴别诊断价值

目的探讨脊髓MRI对多发性硬化(MS)的诊断和鉴别诊断价值。资料与方法80例早期MS患者作为研究对象,作脑部和脊髓MRI检查,分析脊髓和脑部病灶的特征,脊髓病变的发病率与MS诊断的相关性。结果(1)80例脊髓检查中,脊髓异常者65例(81.25%),其中颈髓18例(27.69%),胸髓13例(20.0%),腰骶髓5例(7.69%),颈髓和胸髓同时受累29例(44.62%)。(2)脊髓局灶性病灶37例(46.25%),弥漫性11例(13.75%),局灶并弥漫性病灶17例(21.25%)。(3)不联合脊髓病灶53例可诊断为MS,敏感性为66.25%,若1个脊髓病灶替代1个脑部病灶,68例可诊断为MS,敏感性为85%,两者差异具有统计学意义(P<0.05)。结论脊髓MRI可显示MS在空间的播散性,能提高MS诊断的敏感性也有助于对MS的鉴别诊断。     

上颈椎疾病手术方法选择

 目的 分析上颈椎疾病的病因、寰枢椎复位和脊髓受压情况,探讨上颈椎疾病的手术方法选择.方法 2003-01至2007-06收治169例上颈椎疾病,根据病因分为:上颈椎骨折74例,先天性上颈椎疾病65例,肿瘤21例,其他病因导致寰枢椎不稳9例.根据病因、寰枢椎复位情况和脊髓受压情况分别采用前路手术、后路手术或者前后路手术.结果 28例可复位齿状突骨折患者采用前路空心螺钉内固定.97例上颈椎可复位,脊髓前方无明显受压患者采用单纯后路复位内固定,取自体松质骨植骨融合.44例难复位或脊髓前方明显受压患者采用前路减压、复位,后路内固定、取自体松质骨植骨融合.结论 根据上颈椎疾病病因、复位和脊髓受压情况,应分别选择前路、后路或者前后路联合手术治疗.     

磁共振脊髓成像诊断椎管病变的价值

探讨ＭＲＭ诊断椎管病变的价值及ＭＲＭ技术方法。材料与方法：对７１例椎管病变的常规ＭＲＩ检查及ＭＲＭ表现进行了分析,其中髓内肿瘤８例,髓外硬膜内肿瘤１４例,硬膜外肿瘤９例,结核３例,脊椎外伤７例,脊柱闭合不全６例,椎间盘突出及骨性椎管狭窄２４例。     

Gas in the spinal canal in association with the lumbosacral vacuum phenomenon: CT findings

Summary Twenty-two of 79 patients examined for lumbar spinal stenosis with CT showed the vacuum phenomenon. Three of these cases also had free gas in the spinal canal. The CT findings of vacuum phenomena and free gas in the spinal canal are discussed.     

聚醚醚酮融合器及椎弓根固定系统治疗腰椎退行性病变疗效观察

目的探讨后路椎管减压,单枚聚醚醚酮融合器植入及椎弓根螺钉固定系统治疗腰椎退行性病变临床疗效。方法2006年1月～2009年1月采用单枚聚醚醚酮椎间融合器治疗54例腰椎退变患者,其中男35例,女19例,年龄42-70岁,平均年龄57．2岁;其中腰椎间盘突出症26例,腰椎管狭窄16例,腰椎滑脱8例,退变性侧凸4例。结果平均随访2年（1-4．5年）。采用Nakai及Suk评分标准判定结果,优32例,良14例,可8例,优良率85％,术后椎间融合率96．3％。结论腰椎退行性病变患者在行后路减压,单枚聚醚醚酮椎间融合器植入及椎弓根系统治疗后,疗效满意,融合率高,是治疗腰椎退行性病变的良好方法。     

肠道病毒71型感染手足口病合并神经系统损害的MRI表现

目的 探讨肠道病毒71型(EV71)感染手足口病(HFMD)合并神经系统损害的MRI表现及特征.方法 回顾性分析海南省EV71感染流行期间25例伴有神经系统损害HFMD患儿临床、MRI表现,并结合文献分析其可能机制.结果 HFMD合并急性弛缓性麻痹(AFP)5例,典型MRI表现为矢状面脊髓内长条形长T1、长T2信号,横断面显示相应节段脊髓前角点状长T2信号,增强扫描部分前角、脊神经前根明显强化.HFMD合并脑干脑炎15例,MRI横断面显示桥脑、延髓、中脑后部长T1、长T2信号.HFMD合并无菌性脑膜炎5例,缺乏特异性MRI表现,若发现硬膜下腔增宽、脑膜强化及脑积水等征象则是无菌性脑膜炎的间接证据.结论 MRI是评价EV71型感染HFMD神经系统损害的有效方法,损害部位常位于脑干被盖部、脊髓前角,影像表现具有相对特异性.     

儿童显性脊柱裂的MRI诊断

目的：总结儿童显性脊柱裂的顺影像，提高对该疾病的诊断水平。方法：搜集1995～2002年间经手术病理证实的39例儿童显性脊柱裂的MRI资料，分析其影像表现。结果：本组显性脊柱裂包括脂肪脊髓脊膜膨出18例，脂肪脊膜膨出4例，脊髓脊膜膨出2例，脊膜膨出14例，血管脂肪瘤1例。结论：显性脊柱裂临床诊断并不难，为确定疾病类型和准确定位，MRI当属无创性的首选检查方法。     

脊柱骨折的X线和CT扫描影像对照分析

目的比较和评价常规X线片和CT扫描二种影像学方法在脊柱骨折诊断中的作用.方法对110例X线平片和CT扫描确诊为脊柱骨折的病例进行对照分析.结果110例中椎体骨折共133个,X线侧位片PVBL线67例呈光滑,43例有不同程度异常.CT扫描诊断稳定性骨折53例,不稳定性骨折57例,椎管无狭窄11例,狭窄19例.结论脊柱外伤性骨折影像诊断应注重常规X线平片和CT扫描检查的互补作用.X线片仍是首选检查方法,有利于多个椎体连续或跳跃性同时骨折的检出,发现有椎体骨折均应做CT扫描,以判断骨折的稳定性与并发症情况,有利于临床及时正确处理.     

腰椎退行性病变CT分型(附1180例分析)

目的综合分析腰椎退行性病变的CT表现。方法分析1180例退变性腰腿痛患者的腰椎CT表现,按腰椎相关结构对其表现分类,结合临床表现,对腰椎退变的影像表现进行分型诊断。结果腰椎退变存在6种类型,即:椎间盘退变型,退变率65.3%;骨质退变型,退变率48.1%;椎小关节退变型,退变率36.0%;韧带退变型,退变率25.4%;退变性腰椎管狭窄,退变率44.0%;退变性腰椎失稳,退变率25%。前4种为原发性腰椎退变型,后2种为继发性腰椎退变型。结论腰椎退行性病变的CT分型有利于临床治疗。     

Spinal myelopathy resulting from decompression sickness: MR findings in a case and review of the literature

This is a case report of diving related decompression sickness causing spinal cord symptoms and unique MR findings. The clinical and imaging manifestations are examined, while the pathophysiology of decompression sickness is reviewed. The variety of imaging findings from similar reported clinical cases have are also discussed. Electronic Publication     

X线平片和CT在脊柱骨折诊断中的联合应用价值

目的：评价常规X线和CT扫描二种影像方法在脊柱骨折诊断中联合应用的价值。方法：对120例X线平片和CT扫描诊断为脊柱骨折的病例进行对照分析。结果：120例中椎体骨折共144个，76例X线侧位片椎体后缘连线（PVBL线）光滑，44例有不同程度异常。CT扫描稳定性骨折59例，不稳定性骨折61例，三柱骨折中椎管无狭窄10例，狭窄23例。结论：脊柱外伤性骨折影像诊断应注重常规X线平片和CT扫描检查的互补作用。X线片仍是首选检查方法，有利于多个椎体连续或跳跃性同时骨折的检出，发现有椎体骨折均应做CT扫描，以判断骨折的稳定性与半发症情况，有利于临床及正确处理。     

肠道病毒71型感染手足口病合并急性弛缓性麻痹的脊髓MRI特征

目的 探讨肠道病毒71型(EV71)感染手足口病合并急性弛缓性麻痹(AFP)的脊髓MRI特点.方法 回顾性分析8例EV71感染手足口病合并AFP患儿临床及影像资料,总结其脊髓MRJ特点.结果 8例患儿中,单侧下肢无力4例,四肢无力2例,单侧上肢无力和双侧下肢无力各1例,合并脑干脑炎2例.MRI表现为脊髓前角T2WI高信号,T1WI低信号,其中C3～7水平1例,T10至圆锥、T11至圆锥水平5例,两处均受累2例.单侧肢体无力5例,其中2例为单侧脊髓前角受累,3例表现为双侧受累,且患侧病变范围大,信号强度高.1例行增强扫描,表现为受累脊髓前角轻度强化,同侧前根明显强化.双侧肢体无力3例,均表现为双侧脊髓前角受累.结论 MR平扫及增强检查是诊断EV71相关AFP所致的脊髓神经根病变的首选的影像检查方法.     

肠道病毒71感染手足口病合并急性弛缓性麻痹的脊髓MRI表现及肌力的2年随访研究

目的探讨肠道病毒71型(EV71)感染手足口病合并急性弛缓性麻痹(AFP)的起病及恢复期的脊髓MRI特点,并观察影像学和肌力变化之间的相互关系。资料与方法搜集2008年6至10月EV71感染手足口病合并AFP患儿8例,对其脊髓MRI表现及肌力进行2年随访观察。结果本组8例,单侧下肢无力4例,双侧下肢无力2例,单侧上肢无力和双侧上肢无力各1例,合并脑干脑炎4例。MRI病变特异性累及脊髓前角,上肢无力累及颈膨大,下肢无力累及腰膨大,T2WI高信号。单侧肢体无力5例,其中2例为单侧脊髓前角受累,3例表现为双侧受累,患侧病变范围大,信号强度高。双侧肢体无力3例,脊髓前角病变范围大的一侧肌力下降明显。2年后复查,8例均表现脊髓前角病变范围减小,肌力提高者10肢,肌力下降1肢,新出现肌力下降者1肢。T2WI呈高信号及稍高信号6例,肌力均达4级以上,呈脑脊液信号2例,肌力未达4级。结论脊髓MRI是诊断和随诊EV71感染手足口病合并AFP的最佳影像学检查方法。起病时病变累及脊髓前角区,单侧或双侧受累,以一侧为主多见。恢复期病变范围均有不同程度吸收,多数病变T2WI信号减低。起病时病变范围与肌力下降程度相一致,恢复期T2WI病变区仍呈脑脊液信号者肌力恢复较差。脊髓MRI对EV71感染手足口病合并AFP的临床预后评估具有一定的价值。     

Spinal hyperostosis as an important sign indicating spine injuries on postmortem computed tomography

Although spine injuries are not always detectable on postmortem computed tomography (PMCT), spinal hyperostosis, an important risk factor for spine injury, is relatively easily detectable on PMCT. We therefore examined the utility of the detection of spinal hyperostosis on PMCT as an indicator of spine injury. Full-body PMCT images of 88 autopsy cases with a bruise on the face or forehead but no identifiable skull fracture were reviewed prior to autopsy for the identification and classification of spinal hyperostosis. Spine injuries were observed in 56.0% of cases with spinal hyperostosis and 1.6% of cases without spinal hyperostosis. Among the cases with spinal hyperostosis, spine injuries were observed in 66.7% of cases at stage 2 or 3 and in 88.9% of cases at stage 3. Spine injuries were diagnosed on PMCT in 33.3% of cases prior to autopsy. A significant association was found between spinal hyperostosis and presence of spine injury that cannot be detected on PMCT, indicating that the identification of spinal hyperostosis on PMCT may assist in detecting spine injuries. This finding suggests that investigation of the presence of spine injury based on the identification of spinal hyperostosis on PMCT may assist in determining the correct cause of death by autopsy.     

先天性脊柱裂与脊髓栓系综合征的手术治疗

目的　探讨先天性脊柱裂与脊髓栓系综合征的手术特点及治疗经验。方法　脊柱裂与脊髓栓系综合征是一种先天性疾病。本文总结了 1993年 9月～ 2 0 0 3年 2月收治的 5 2 8例先天性脊柱裂与脊髓栓系患者的显微手术情况。年龄 5个月～ 4 5岁 (平均 9岁) ,其中脊膜膨出 2 39例 (4 5 3% ) ,脊髓脊膜膨出 12 3例(2 3 3% ) ,脊柱裂伴脂肪瘤 10 7例 (2 0 3% ) ,隐性脊柱裂 5 9例 (11 2 % )。结果　在手术的 5 2 8例患者中 ,临床症状改善 32 2例 (6 1% ) ,无变化 194例 (36 7% ) ,症状加重 12例 (2 3% )。结论　对于脊柱裂手术 ,除了要去除局部硬脊膜囊及其他组织的压迫和松解脊髓栓系外 ,还应考虑病人的远期再粘连问题。     

急性脊椎外伤的MRI诊断价值

目的: 评价MRI诊断急性脊椎外伤的价值.材料和方法: 回顾性分析18例急性脊椎外伤的MRI表现.结果: 18例急性脊椎外伤中MRI清楚显示椎体骨折14个,椎体脱位4个,椎间盘突出13个,急性脊髓损伤11个,其中不同程度脊髓受压损伤8例,离断3例.结论: MRI能清楚显示椎体骨折、椎体滑脱、椎间盘突出、脊髓损伤等细节情况,是急性脊椎外伤首选的影像检查方法.     

Spinal cord angiomas diagnosed by gas myelography

Summary Three cases with spinal cord arteriovenous malformations are reported with characteristic changes evident on gas myelography. The malformations were confirmed by selective spinal angiography in all cases and surgically removed in 2 of the cases.     

Evaluation of Pott's disease with computed tomography

Summary The CT appearance of eight cases of culture-positive spinal tuberculosis is reviewed. Three patients had single level vertebral involvement, while five others showed multilevel involvement. In seven of eight cases, paraspinal soft tissue involvement was seen. In two, the process caused neurologic symptoms by extending into the epidural space. In three patients the paraspinal extension was not only local, but spread along multiple levels. The CT appearance can be highly suggestive of TB in cases where the diagnosis has not been suspected. In cases where the diagnosis is suspected by plain films, CT can display unsuspected extension of the disease and be helpful in needle localization for aspiration.     

Enhanced cervical MRI in identifying intracranial dural arteriovenous fistulae with spinal perimedullary venous drainage

Diagnosis of an intracranial dural arteriovenous fistula (DAVF) with spinal perimedullary venous drainage is challenging because the presenting symptoms are usually related to dysfunction of the spine, not of the brain. Repeated spinal angiograms are usually performed before the diagnosis is finally made by cerebral angiography. We report two cases of intracranial DAVFs with spinal perimedullary venous drainage. In both cases contrast-enhanced cervical MRI demonstrated dilated lower brainstem and upper spinal veins, which, we believe, is a good indicator of the existence of such drainage. We suggest that, in cases with perimedullary serpentine enhancement on thoracic or lumbar MR images, additional Gd-enhanced cervical spinal MR imaging should be performed. The simple process of tracing the veins upwards may avoid a lot of unnecessary examinations and delay in the diagnosis. Received: 3 July 1997 Accepted: 6 August 1997     

脊髓畸胎瘤的影像诊断

目的　探讨脊髓畸胎瘤的影像诊断。方法　分析 10例脊髓畸胎瘤的临床和影像表现。髓内 8例 ,髓外 2例。全部病例均作MR扫描。结果　 5例腰段 ,3例胸段 ,1例胸腰段 ,1例颈段。 7例多囊腔 ,3例单囊腔。MR显示肿瘤呈混杂信号 ,T1WI脂肪抑制增强扫描后病灶内脂肪信号消失 ,肿瘤部分不均匀强化。 3例腰段脊髓畸胎瘤伴有脊髓低位。结论　脊髓畸胎瘤MR表现具有特征性 ,MR的T1WI脂肪抑制增强扫描是正确诊断脊髓畸胎瘤最有效的方法