自发性脊髓硬膜外血肿MRI诊断

MRI diagnosis of spontaneous spinal epidural hematoma

目的:探讨自发性脊髓硬膜外血肿MRI表现及其鉴别诊断。材料与方法:9例自发性脊髓硬膜外血肿,男4例,女5例,年龄9～57岁,平均36岁。所有病例均无明确外伤史。常规行SET1WI矢状位及轴位,T2WI矢状位及轴位。7例注射Gd-DTPA行增强扫描。结果:9例自发性脊髓硬膜外血肿中,位于椎管内背侧8例,仅1例位于椎管内腹侧,累及3～5个椎体节段,平均4个椎体节段。颈段4例,颈胸段4例,腰段1例。血肿呈新月形及长条状。3例血肿呈T1WI及T2WI高信号,4例血肿T1WI呈等信号,T2WI呈高信号。2例T1WI及T2WI均呈等高混杂信号。血肿与脊髓间T1WI及T2WI均可见低信号线相隔,以T2WI明显。增强扫描3例见血肿壁强化,4例未见强化。结论:MRI是自发性脊髓硬膜外血肿最佳检查方法,可清楚显示血肿部位、范围、血肿的新旧程度及脊髓受压受损情况。

Objective： To investigate the MRI findings and differential diagnosis of spontaneous spinal epidural hematoma. Methods： There were 9 cases of spontaneous spinal epidural hematoma. Four were male and 5 were female. All cases did not have history of trauma. The routine SE T1WI and T2WI sagittal and transversal planes were performed with MRI scanner. Seven cases were examined by enhanced MRI. Results： The hematomas located at the dorsum of spinal canal in 8 cases and at the ventral side of spinal canal in I ease. The hematomas covered 3 to 5 vertebral bodies with average of 4 vertebral segments. There were 4 cases at cervical segment, 4 cases at cervicothoracie segment, 1 case at lumbar segment. The hematomas had crescent or long ribbon shape. Hematomas in 3 cases were of homogeneous high signal on T1WI and T2WI, 4 cases were of medium signal on T1WI and high signal on T2WI. Two eases had heterogeneous high signal both on T1WI and T2WI. There was a low signal septum between spinal cord and henatoma on T1WI and T2WI, especially clear on T2WI. The wall of hematoma was enhanced in 3 cases on MRI enhancement scan. Conclusion： MRI is the best method in diagnosing spontaneous spinal epidural hematoma. It not only can show clearly the location and the extent of hematoma clearly, but also the age of hematoma and injury of the spinal cord.