自发性脊髓硬膜外血肿的MRI诊断及鉴别诊断

MRI diagnosis and differential diagnosis of spontaneous spinal epidural hematoma

目的探讨自发性脊髓硬膜外血肿的MRI表现及鉴别诊断。方法11例自发性脊髓硬膜外血肿，男7例，女4例，年龄27～74岁，均无明确外伤史。常规行SET1WI、T2WI矢状位及T2WI轴位，部分病例行脂肪抑制扫描，6例注射Gd-DTPA后行增强扫描。结果11例自发性脊髓硬膜外血肿中，9例位于椎管内背侧脊髓后方，2例位于椎管内背外侧。病变范围覆盖4～5个锥体节段，颈段8例，胸段3例。血肿呈长条状及长梭形，5例血肿呈T1WI、T2WI高信号，4例血肿呈T1WI、T2WI等、低、高混杂信号，2例呈T1WI及T2WI等信号。增强扫描2例血肿壁强化，4例未见强化。结论MRI是脊髓硬膜外血肿最佳检查方法，能清楚显示血肿部位，范围，区分急慢性血肿。

Objective To investigate the MRI finding and differential diagnosis of spontaneous spinal epidural hematoma （SSEH）. Methods Eleven cases of SSEH were enrolled, 7 male and 4 female, aged 27-74 years, without clearly history of trauma. The routine SE T1WI and T2WI saglttal and transversal planes were performed with MRI scanner, part of them were performed faty inhibition. Six cases were enhanced examination by inject Gd-DTPA. Results Nine of 11 cases of SSEH located at the dorsum of spinal canal and 2 cases at the beside dorsum of spinal canal. The hematomas covered 4 to 5 vertebral bodies. There were 8 cases at cervical segment, 3 cases at thoracic segment. The hematomas had long ribbon or shuttle shape. Hematomas in 5 cases were of homogeneous high signal on T1WI and T2WI, 4 cases were of medium, low and high mixed signal, two cases had medium signal both on T1WI and T2WI. The wall of hematomas were enhanced in 2 cases on MRI enhancement scan. Conclusion MRI is the best method in diagnosing SSEH. It can not only show clearly the location and the extent of hematoma clearly, but also the age of hematoma, and display the injury of spinal cord.