脊髓动静脉性血管病变的误诊分析

Analysis of the misdiagnosis in the spinal cord arteriovenous lesions

目的:分析脊髓动静脉性血管病变的误诊原因。方法:回顾性分析66例脊髓动静脉性血管病变患者的资料。结果:66例脊髓动静脉性血管病变中,脊髓动静脉畸形36例,硬脊膜动静脉瘘21例,髓周动静脉瘘9例。经磁共振成像检查后仍有44例次发生过误诊或诊断混淆,其中曾被误诊过的疾病主要有椎管内肿瘤19例,脊髓积水症6例,椎间盘突出5例,急性脊髓炎5例,另有4例硬脊膜动静脉瘘和3例髓周动静脉瘘被误诊为脊髓动静脉畸形。结论:诊断脊髓动静脉性血管病变时,需注意与上述疾病鉴别;行磁共振成像检查,发现血管流空影和作脊髓数字减影血管造影检查,是正确诊断的关键。

Objective To analyze the cause of the misdiagnosis in the spinal cord arteriovenous lesions. Methods The clinical data of 66 patients with spinal cord arteriovenous lesions from Aug 1990 to Dec 2003 were reviewed. Results Among 66 patients with spinal cord arteriovenous lesions, 36 patients had the spinal arteriovenous malformations, 21 had the spinal dural arteriovenous fistulae and 9 had the intradural perimedullary arteriovenous fistulae. Forty-four misdiagnosis took place even after the examination of the magnetic resonance imaging. Ninety patients were once misdiagnosed the intraspinal tumor, 6 hydromyelia, 5 intervertebral disc herniation, and 5 acute myelitis. In addition, 4 patients with spinal dural arteriovenous fistulae and 3 patients with intradural perimedullary arteriovenous fistulae were misdiagnosed the spinal arteriovenous malformations. Conclusions Spinal cord arteriovenous lesions should be differentiated from the above-mentioned diseases. The key to the correct diagnosis lies in the careful evaluation of MRI to find out low signal flow voids representing vessels and in the spinal DSA examination.