儿童椎管内结核瘤的MRI特征分析

Magnetic resonance imaging features of intraspinal tuberculosis in children

目的探讨儿童椎管内结核瘤的核磁共振成像(magnetic resonance imaging,MRI)特征。方法回顾性分析重庆医科大学附属儿童医院2008-2021年经手术病理或随访证实的22例儿童椎管内结核瘤的临床和MRI资料,按部位分为3组:髓内5例,髓外硬膜下8例,硬膜外9例。分析病变的形态、MRI信号和强化模式等特征。结果髓内结核瘤呈圆形或类圆形,而髓外硬膜下和硬膜外结核瘤呈长梭形或斑块状;髓内和髓外结核瘤MRI信号均以T1WI等信号(15/22)、T2WI低信号(11/22)或等信号(7/22)为主;增强后髓内结核瘤呈环形强化(5/5),而髓外结核瘤多为显著均匀强化(13/17)。10例(10/22)椎管内结核瘤发生于抗结核治疗中,其中髓外硬膜下结核瘤7例(7/8),发生率显著高于硬膜外结核瘤(2/9)和髓内结核瘤(1/5)。结论儿童椎管内结核瘤MRI显示T1WI等、T2WI低/等信号以及环形或明显均匀强化;抗结核治疗过程中及时MRI检查有利于尽早发现椎管内结核瘤病变。

Objective To investigate the features of magnetic resonance imaging(MRI)of intraspinal tuberculoma in children.Methods The clinical and MRI data of 22 child patients with intraspinal tuberculoma confirmed by surgical pathology or by clinical follow-up in our department during 2008 and 2021 were collected and retrospectively reviewed.According to the location of tumor,they were divided into intramedullary(n=5),intradural extramedullary(n=8)and epidural tuberculoma(n=9)groups.The lesion shapes,signal and enhancement patterns were analyzed.Results Intramedullary tuberculoma had a round or round-like shape,while extramedullary tuberculoma presented as long-fusiform or en plaque shapes.Both intramedullary tuberculoma and extramedullary tuberculoma were mainly isointense(15/22)on T1-weighted images(T1 WI)and hypointense(11/22)or isointense(7/22)on T2 WI.Rim enhancement(5/5)was observed in intramedullary tuberculoma,and remarkable homogeneous enhancement(13/17)was dominant in extramedullary tuberculoma.The intraspinal tuberculomas occurred during anti-tuberculosis therapy in 10 cases,including 7 cases(7/8)of intradural extramedullary tuberculomas,with a significantly higher rate than epidural tuberculoma(2/9)or intramedullary tuberculoma(1/5).Conclusion MRI of intraspinal tuberculoma is characterized by isointense on T1 WI,hypointense/isointense on T2 WI,and rim or remarkable homogeneous enhancement.The occurrence of intraspinal tuberculoma should be vigilant during anti-tuberculosis treatment.Timely MRI examination is beneficial to early detection of intraspinal lesions.