硬脊膜动静脉瘘的影像学表现与临床诊断

Clinical and Radiologic Features of Spinal Dural Arteriovenous Fistulas

目的:分析硬脊膜动静脉瘘(SDAVF)的影像学与临床表现,探讨其临床诊断方法。方法:回顾性分析36例SDAVF患者的临床资料以及影像学表现。结果:36例患者均有不同程度的双下肢感觉障碍、运动障碍与括约肌功能障碍。脊髓MRI检查示所有患者均有脊髓水肿信号,脊髓前后有葡行的血管流空影;部分患者有脊髓软化坏死信号。全部患者均经脊髓血管造影明确诊断。结论:SDAVF以中老年男性多见,主要表现为进行性加重的运动和感觉功能减退、大小便及性功能障碍,脊髓MRI可对其进行初步诊断,确诊及瘘口的精确定位有赖于选择性脊髓血管造影。

Objective： To analyze the radiological findings and to discuss the clinical manifestations of spinal dural arteriovenous fistulas （SDAVF）. Methods： The clinical features and radiological structural changes of 36 patients with SDAVF were analyzed retrospectively. Results： Motor and sensory deficits in the legs were found in all the patients. A centrally located hyperintense signal on T2-weighted images signifying the swelling of the spinal cord and the hypointense ＂flow void＂ phenomena dorsal to the cord, characterized the enlarged and tortuous veins in all the cases. The signal of spinal cord necrosis was seen in some patients. Spinal angiography was done in all the patients to verify the diagnosis. Conclusion： Middle-aged men were mostly affected by this disorder, manifesting progressive motor and sensory deficits in the legs. MRI was a reliable diagnostic method, but catheter angiography was required to localize the fistula as well as the angio-architectures, on which the mode of treatment depends.