多层螺旋CT血管成像在评价脊髓血管畸形中的价值和限度

Evaluation of spinal cord vessels using multi-slice CT angiography

目的评价多层螺旋CT血管成像(CTA)在脊髓血管畸形诊断中的意义。方法11例临床怀疑脊髓血管病变的患者全部行多层螺旋CTA和DSA检查,其中6例脊髓DSA结果正常,另5例脊髓DSA证实为脊髓血管畸形[1例硬膜内髓周动静脉瘘(AVF),4例硬膜AVF]。采用16层螺旋CT,多相扫描模式,冠状面和矢状面重组,并与DSA相对照,分析CTA上正常和异常脊髓血管表现。结果与DSA对照,6例脊髓DSA检查阴性者中,CTA上可辨认的血管为脊髓前正中静脉或脊髓前动脉。5例脊髓DSA证实为脊髓血管畸形患者中,CTA均显示了异常血管,1例硬膜内髓周AVF,CTA上清晰显示了供血的脊髓前动脉与髓周静脉的直接交通,表现为扩大、发夹样、扭曲状的血管影,另4例硬膜AVF,CTA上异常血管与DSA上的扭曲引流静脉相符合,在静脉期上表现更为明显,但供血的根软膜动脉或软膜动脉在CTA上没有显示。结论多层螺旋CTA能够区分脊髓正常或异常血管,作为一种无创性的检查方法,可以用来筛选是否有脊髓血管畸形,并可以作为脊髓血管畸形患者手术后随访的有效手段。

Objective To evaluate the value of Multi-slice spiral CT angiography for spinal cord vessels. Methods 11 adult subjects with suspected of myelopathy were performed with Multi-slice spiral CT angiography, An iodine contrast agent was injected at 3.5 ml/s, for total 100 ml. The parameters were axial 16 slice mode, 0. 625 mm slice thickness, 0. 8 s rotation, delay time depending on smartprep（ 15-25 s）, multi-phase scan. The coronal and sagittal MPR and SSD were generated on a workstation compared with spinal digital subtraction angiography （DSA） to analyze normal or abnormal spinal cord vessels. Results Normal findings at spinal CTA and digital subtraction angiography in six adult normal subjects and spinal cord vascular malformations（ 1 intradural extramedullary AVF, 4 dural AVFs） in five cases, Recognizable intradural vessels corresponding to anterior median （midline） veins and/or anterior spinal arteries were show in six adult normal subjects. Abnormal intradural vessels were detected in all five spinal cord vascular malformation with CT angiography , in comparison with digital subtraction angiography these vessels were primarily enlarged veins of the coronal venous plexus on the cord surface, radiculomedullary-dural arteries could not be clearly shown in four dural AVF, only one anterior spinal artery was detected in one patient with intradural medullary AVF, which direct shunt between anterior spinal artery and perimedullary vein with tortuous draining vessel. Conclusion Multi-slice CT angiography is able to visualize the normal or abnormal spinal cord vessels. It could be used as a noninvasive method to screen the spinal cord vascular disease.