椎管内硬膜外血肿的MRI表现

MRI Diagnosis of Spinal Epidural Hematomas

目的探讨椎管内硬膜外血肿(SEH)的MRI表现特征。方法对11例经手术证实,1例经临床综合治疗复查后SEH进行回顾性分析。12例患者均常规平扫,其中3例同时进行增强扫描。采用ToshibaFLAXART0.5机型及GE1.5T双梯度超导MR扫描仪,采用脊柱相控阵线圈。常规行脊柱矢状为SET1WI、FSET2WI或FRFSET2WI序列,8例加扫矢状、冠状面或横断面脂肪抑制序列T2WI,层厚4.5mm、层间距0.5mm,3例同时行增强扫描,采用钆喷酸葡甲胺(Gd-DTPA)对比剂经静脉团注,注射剂0.1mmol/kg。行矢状、冠状或横断面增强T1WI或脂肪抑制T1WI扫描,层面及参数同平扫。结果颈段2例,胸段5例,胸腰段3例,腰段2例;位于脊膜囊后方11例,脊膜囊前方1例。血肿分别呈长T1长T2信号、长T1短T2信号、等T1短T2信号及短T1长T2信号,其中3例同时行增强扫描,1例见多发斑片状轻-中度强化,1例边缘轻度强化,1例未见强化。结论 SEH的MRI表现具有一定的特征性,对其诊断及鉴别诊断有着重要的价值。

Objective To study the MRI features of spinal epidural hematomas （SEH）, and its value on diagnosis and differential diagnosis. Methods The MRI characteristics of 12 cases （8 men and 4 women, median age 38.5） with SEH confirmed by operation and re-examination after conservative treated were studied retrospectively. MR images were obtained with 0.5T scanner （Toshiba FLAXART） and 1.5T scanner （GE）. MRI was performed in all patients in sagittal SE T1WI and SE or FSE T2WI with 4.5mm slice thickness and 0.5mm slice interval, 12 in axial FSE T2WI, 8 in axial SE T1WI. Fat suppression sequences were performed in 8 cases. 3 cases were performed axial, sagittal and coronal SE T1WI or Fats T1WI after applying Gd-DTPA at the same time. Results Two cases in cervical spine, 5 in thoracic spine, 3 in thoracic and lumbar spine, and 2 in lumbar spine. The hematomas located at pre-epidural space in 1 case （1/12） and at posterolateral epidural space in 11 segments （11/12）. The hematomas showed variable signal intensity. One showed hypointensity signal to cord on T1WI and hyperintensity on T2WI, 2 hypointensity on T1WI and hypointensity on T2WI, hyperintensity, 3 isointensity on T1WI and hypointensity on T2WI, 1 isointensity/ hyperintensity on T1WI and isointensity/ hyperintensity on T1WI, 5 hyperintensity on T1WI and hyperintensity on T2WI. One showed slight-moderate inhomogeneous enhancement, one slight enhancement on the brim, and one no enhancement after contrast administration. Conclusion SEH is a rare disorder. The MRI features are characteristic and importance for the diagnosis and differential diagnosis.